Reducing the Hypertensive Effects of the Prolonged Surgical Tourniquet Using a Dual-Cuff Strategy: A Prospective Randomized Controlled Trial

Stimpson, James; Gill, Damien; Memarzadeh, Arman; Dunne, Mike; Perry, Laura A.; Magan, Ahmed; Devany, Adam; Pasapula, Chandra

doi:10.1053/j.jfas.2019.03.019

Cited by 4 publications

(4 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ischemia plays an important role in the total conduction block after 15 to 45 minutes when saline is injected instead of local anesthetics under the conditions similar to those of clinical IVRA, leading to a complete sensory blockade of the limb and skin [15]. It has been stated that tourniquet pain increases linearly with hypertensive tendency and occurs within an hour [16]. In our study, it was observed that the required amount of sedoanalgesic consumption increased with time.…”

Section: Discussionsupporting

confidence: 51%

Comparing two different lidocaine concentrations in addition to the tourniquet application to incorporate in the Intravenous Regional Anesthesia (IVRA) Method for reducing the total amount of local anesthetic in hand and wrist surgeries: A randomized cohort study

et al. 2021

View full text Add to dashboard Cite

Modified approaches are emphasized to make the traditional IVRA method more reliable and effective. We aimed to compare two different concentrations used with temporary tourniquet application in addition to the IVRA method for reducing local anesthetics amount in hand and wrist surgeries. Material and methods: After the approval of Gaziantep University Ethics Committee had been obtained, observation forms of patients with ASA physical score I-II who had undergone elective orthopedic upper extremity surgery were reviewed retrospectively. The patients were divided into two groups according to the concentration of 150 mg of lidocaine in saline. The patients were administered 150 mg lidocaine in 15 ml (Group 15, n:29) and 20 ml (Group 20, n:26) saline. Patients were enrolled into groups in a random and a blind fashion, and after the exclusion criteria were assessed, twenty patients from each group were evaluated. Demographic data, the classification of operation time, the peri-operative follow-up values, the sedoanelgesia consumption needs and the postoperative patient satisfaction scores were compared. Results: Demographic data were similar in both groups. The tourniquet time was 40.75±14.71 minutes in Group 15 and 38.25±9.77 minutes in Group 20 (p=0.531). Sedation start time was 23.18±9.02 in Group 15 (n=11) and 26.53±6.57 minutes in Group 20 (n=13) (p=0.304). Tourniquet pain time was 46.66±2.88 in group 15 (n=3) and 50.00±7.07 minutes in group 20 (n=2) (p=0.624). No statistically significant difference was found between the alltime classifications, hemodynamic values, peri-operative sedoanalgesia consumptions, and the patient satisfaction scores between the groups (p>0,05). A continuous increase in sedoanalgesic consumption amount with time was observed. None of the patients had signs of local anesthetic toxicity. Conclusion: We suppose that the plasticity inherent to the IVRA may be optimized by alternative adaptations to be used for decreasing the amount of local anesthetic to safer levels and for reducing the risk of related side effects.

show abstract

Section: Discussionsupporting

confidence: 51%

Comparing two different lidocaine concentrations in addition to the tourniquet application to incorporate in the Intravenous Regional Anesthesia (IVRA) Method for reducing the total amount of local anesthetic in hand and wrist surgeries: A randomized cohort study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The hypertensive tendency is linearly correlated with the increasing levels of tourniquet discomfort over time and this tendency may reach an uncontrollable level. The tourniquet pain can be observed for 60 minutes along with a hypertensive tendency that has an unknown cause and may develop even under general anesthesia depending on insufficient tourniquet tolerance (15). The hypertensive tendency might be prevented with the sedo-analgesia protocol in our study.…”

Section: E a R L Y A C C E S Smentioning

confidence: 81%

İntravenöz Rejyonel Anestezi (IVRA) Sırasında Ayak ve Ayak Bileği Ameliyatları için İki Farklı Konsantrasyonun Karşılaştırılması: Randomize Kohort Çalışma

Mendes

Şen

Cesur

et al. 2022

Düzce Tıp Fakültesi Dergisi

View full text Add to dashboard Cite

Aim: Intravenous regional anesthesia (IVRA) is not commonly preferred in the lower extremity because of the toxic risks of high-dose local anesthetics. This study aimed to compare the use of two different concentrations of anesthetics with additional tourniquet application to reduce local anesthetics amount during the IVRA method for short-term foot and ankle surgeries. Material and Methods: In this prospective study, 40 patients were allocated to two groups with different concentration formulations of 200 mg lidocaine hydrochloride (Group 30 and Group 20). The groups were compared in terms of demographic data, tourniquet pain, operation time, hemodynamic indicators, and sedo-analgesia needs. Results: Demographic data were similar in the two groups. The mean tourniquet pain time was 41.66±6.61 minutes in Group 20 (n=9) and 36.76±7.17 minutes in Group 30 (n=13) (p=0.120). Perioperative sedo-analgesia consumptions were similar between the groups: weight-adjusted before/after tourniquet pain (p=0.390, p=0.207, p=0.536, and p=0.176), weight-adjusted/none total amount (p=0.425, p=0.578, p=0.268, and p=0.612), per minute before/after tourniquet pain (p=0.075, p=0.506, p=0.354, and p=0.055), for propofol and remifentanil, respectively. There was a significant difference between the propofol and remifentanil consumption per minute before and after the tourniquet pain in both groups: 5.61±1.67 and 14.58±6.62 mg/min propofol (p=0.001), and 4.79±1.69 and 7.86±1.55 mcg/min remifentanil (p=0.001), respectively. No patient had signs of local anesthetic toxicity. Conclusion: Low-dose sedo-analgesia can be used by a modified IVRA method in the management of tourniquet discomfort that may occur until the tourniquet pain develops.

show abstract

“…When VAS scores were evaluated between the groups, the mean intrasurgical and mean postsurgical VAS score was statistically significantly lower in the PFNB group. Although the mean intrasurgical since there is no need to use a tourniquet, risks such as tourniquet pain and ischemia after surgery are avoided (25). One of the most important features, while an experienced anesthesiologist is needed for the PFNB method, the WALANT can easily be applied directly by orthopedic surgeons directly in the surgery of subcutaneous bones such as the lateral and medial malleolus.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the WALANT and the PFNB techniques in the surgical treatment of unimalleolar fractures: a prospective study

Çağlar¹,

Nazlıgül²,

Akcaalan³

et al. 2022

Acta Orthop Belg

View full text Add to dashboard Cite

The popliteal fossa nerve block (PFNB) technique is one of the most popular anesthesia method in the foot and ankle surgery. The wide awake local anesthesia no tourniquet (WALANT) technique is an local anesthetic method and it has been gaining popularity in orthopedic surgery in recent years. Our aim is to compare the efficacy of the WALANT and the PFNB techniques in pain management. This prospective study included 40 patients with lateral malleolar and medial malleolar fractures. The first group was anesthetized using the WALANT technique; in the second group, PFNB was performed. All patients were evaluated for intrasurgical bleeding amounts, mean arterial pressure, surgery time and VAS scores for presurgical pain, pain during the local anesthetic injection sequence, mean intrasurgical pain, mean postsurgical pain. A total of 40 patients in both groups were successfully operated on with the WALANT and the PFNB techniques. When the two groups were compared, statistically significant differences were observed for mean intrasurgical VAS (p = 0.033), mean postsurgical VAS (p = 0.038) and intrasurgical bleeding (p = 0.006). No significant difference was found in pain scores during anesthetic injection (p = 0.529), mean arterial pressure (p = 0.583) and surgery time (p = 0.277). The PFNB technique is more successful in pain management in the treatment of the unimalleolar fractures. Intrasurgical bleeding amounts were less detected in the WALANT tech- nique. The both techniques are a reliable and suitable anesthetic method in the surgical treatment of uni- malleolar fractures.

show abstract

Reducing the Hypertensive Effects of the Prolonged Surgical Tourniquet Using a Dual-Cuff Strategy: A Prospective Randomized Controlled Trial

Cited by 4 publications

References 28 publications

Comparing two different lidocaine concentrations in addition to the tourniquet application to incorporate in the Intravenous Regional Anesthesia (IVRA) Method for reducing the total amount of local anesthetic in hand and wrist surgeries: A randomized cohort study

Comparing two different lidocaine concentrations in addition to the tourniquet application to incorporate in the Intravenous Regional Anesthesia (IVRA) Method for reducing the total amount of local anesthetic in hand and wrist surgeries: A randomized cohort study

İntravenöz Rejyonel Anestezi (IVRA) Sırasında Ayak ve Ayak Bileği Ameliyatları için İki Farklı Konsantrasyonun Karşılaştırılması: Randomize Kohort Çalışma

Comparison of the WALANT and the PFNB techniques in the surgical treatment of unimalleolar fractures: a prospective study

Contact Info

Product

Resources

About