Tourniquet pain in a volunteer study: effect of changes in cuff width and pressure

Abstract

This study examines the relationship between pneumatic tourniquet cuff size, occlusion pressure and the resulting pain. Two tourniquet cuff widths were used, a wide (14 cm) and a narrow cuff (7 cm). Twenty volunteers were divided into two groups for tourniquet application: a pressure group in which the tourniquet was inflated to a pressure equal to the systolic pressure + 100 mmHg, and a saturation group in which the tourniquet was inflated to 10 mmHg above the loss of arterial pulse, as indicated by cessation of pulse waveform on an oximeter. According to a randomised cross-over protocol, subjects were studied using wide and narrow cuffs simultaneously and/or successively on both arms. Pain was assessed by subjects by means of a visual analogue score (0-10 cm). Occlusion pressures were similar for all volunteers in the pressure group and significantly higher than those in the saturation group with both the wide and narrow tourniquets. The wide cuff data turned out to be significantly lower than the narrow cuff results. Subjects in the pressure group could tolerate pain with the narrow cuff for significantly longer than with the wide cuff. However, in the saturation group, volunteers tolerated the wide cuff for longer. Pain intensity increased more rapidly in those in the pressure group with the wide cuff than with the narrow cuff. In contrast, volunteers in the saturation group found the narrow cuff to be more painful than the wide cuff. In conclusion, this study has shown that a wide tourniquet cuff is less painful than a narrow cuff if inflated at lower pressures and at these lower pressures it is still effective at occluding blood flow.

Tourniquet Use in Upper Limb Surgery

“…The duration of pain tolerance improves in sedated patients [11,36]. Hagenouw et al (1986) demonstrated that higher cuff pressures with narrower tourniquet diameters can cause less pain than wider cuffs with lower pressures [11], whereas Estebe (2000) showed that a wide-cuff pneumatic tourniquets improve arterial occlusion and are less painful than narrow cuffs when pressure is limited to arterial pulse loss [17,25].…”

The effect of different phases of synchrony on pain threshold.

“…Pain thresh old is understood to be a valid indicator of endorphin activity because endogenous opioids are released during pain sensation (DePue & Morrone-Strupinsky, 2005;Mueller, 1981). Specifically, the use of a blood pressure cuff to induce specific ischemic pain has been found to be a valid and reliable, as well as noninvasive, protocol to assess endorphin levels (Estebe, Le Naoures, Chemaly, & Ecoffey, 2000;Ryan & Kovacic, 1966). Cohen, Ejsmond-Frey, Knight, and Dunbar (2010) investigated synchronized behaviors in a team of male collegiate rowers, using the pain threshold test as a noninvasive measure of cen tral endorphin activity.…”

Ist die Blockade des N. cutaneus femoris lateralis eine Alternative zu einer klassischen Femoralisblockade bei Kniegelenkarthroskopien?

“…Ne ben der Tour ni quet grö ße, dem In fla tions druck und der Dau er der Tour ni quetan la ge [12,30] als ur säch li che Fak to ren wer den Ad ju van zi en zum Lo kal an äs the tikum wie Clo ni din [14,15] oder Ket amin [15] als schmerz lin dern de Fak to ren dis kutiert. Von meh re ren Au to ren wird al lerdings der lo ka len Haut kom pres si on eine we sent li che Rol le zu ge schrie ben, denn Maß nah men zur ört li chen Be täu bung der Haut durch Li do cain-/Pri lo cain-Sal be oder lo ka le In fil tra tio nen mit Lo kal an äs-the ti ka ver bes sern die Tour ni quet to le ranz [20,24,29].…”