Randomized blinded control trial into tourniquet tolerance in awake volunteers

Abstract

Background: The ability to tolerate a tourniquet is often the limiting factor to elective and emergent procedures of the upper limb performed under local anaesthesia. This study aims to demonstrate that upper limb tourniquets are more predictably and better tolerated when inflated to 200 mmHg than to the traditional inflation pressure of 250 mmHg in awake, unsedated subjects. Methods: Forty healthy volunteers were randomized to have a tourniquet applied at either 200 or 250 mmHg for 20 min. Vital signs and pain scores were measured pre-test, at intervals throughout the time the tourniquet was inflated and post-deflation until the parameters normalized. Grip strength was measured pre-test, immediately post-deflation of the tourniquet and every 2 min until return of normal strength. Results: All subjects were able to tolerate a tourniquet inflated for the allocated 20 min irrespective of the inflation pressure; however, there was a statistically significant lower average pain score in the group where the tourniquet was inflated to 200 mmHg compared with 250 mmHg. There was a quicker return of normal grip strength, although this was not shown to be statistically significant. Conclusions: Tourniquets inflated to 200 mmHg are better tolerated in awake, unsedated subjects that would allow predictably short procedures of the hand, wrist and forearm to be performed under local anaesthesia. It represents a pilot study prior to a further clinical study investigating the efficacy of tourniquets inflated to a lower pressure in maintaining an effective bloodless field.

Transient Tourniquet and Electro-cauterization applied for Surgery in Metacarpal Fractures Under Local Anesthesia with Epinephrine

“…In our cases, tourniquet was instantly in ated to 250 mmHg, and we did not set the respective pressure, with regard to individual situation, such as gender, age, body weight and blood pressure. Although tourniquet compression with 250 mmHg of less than 30 minutes was no harm to the tissue, we believed, less pressure, less uncomfortable, as illustrated by Lim E, et al 27 .…”

Karpal tünel sendromunun lokal anestezi ile yapılan cerrahi tedavisinin sonuçları: turnikeli ve turnikesiz yapılan ameliyatların karşılaştırılması

“…In their prospective randomized controlled study, Iqbal et al [13] reported that the rate of pain complaints in the group of patients undergoing CTS surgery with tourniquet use was significantly higher than in the group of patients operated on without tourniquet use and that tourniquets caused unnecessary pain without any additional benefit. Furthermore, prolonged tourniquet use may cause deep vein thrombosis, pulmonary embolism, local soft tissue, nerve damage, and a temporary/permanent neurologic deficit [12,25,26]. Lim et al [26] reported that patients could tolerate tourniquets for approximately 20 min in their study.…”

“…Furthermore, prolonged tourniquet use may cause deep vein thrombosis, pulmonary embolism, local soft tissue, nerve damage, and a temporary/permanent neurologic deficit [12,25,26]. Lim et al [26] reported that patients could tolerate tourniquets for approximately 20 min in their study. Maury and Roy [27] determined the mean tourniquet tolerance time to be 18 min (range 10-26 min).…”

Re: Randomized blinded control trial into tourniquet tolerance in awake volunteers

“…We thank Maxwell 1 for his interest in our article. 2 Minor hand trauma contributes to a large portion of the case load in plastic surgical units. The majority of cases can be treated in both elective and emergency settings with local anaesthetic (+/− sedation), along with the use of a pneumatic tourniquet to aid in providing a bloodless operating field.…”