A Comparison between Single and Double Tourniquet Technique in Distal Upper Limb Orthopedic Surgeries with Intravenous Regional Anesthesia

Haghighi, Mohammad and Mardani-Kivi, Mohsen and Mirbolook, Ahmadreza and Ghazanfar Tehran, Samaneh and Ashouri Saheli, Nasim and Hashemi-Motlagh, Keyvan and Saheb-Ekhtiari, Khashayar (2018) A Comparison between Single and Double Tourniquet Technique in Distal Upper Limb Orthopedic Surgeries with Intravenous Regional Anesthesia. The Archives of Bone and Joint Surgery, 6 (1). pp. 63-70.

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Background: Several studies have put an effort to minimize the tourniquet pain and complications after conventionaldouble tourniquet intravenous regional anesthesia (IVRA). We expressed in our hypothesis that an upper arm singlewide tourniquet (ST) may serve a better clinical efficacy rather than the conventional upper arm double tourniquet (DT)in distal upper extremity surgeries.Methods: In this randomized controlled trial, 80 patients undergoing upper limb orthopedic surgeries were randomizedinto two groups. IVRA was administered using lidocaine in both groups. Tourniquet pain was recorded based on visualanalogue scale (VAS). In case of pain (VAS>3) in the DT group, the proximal tourniquet was replaced with a distaltourniquet while fentanyl 50μg was injected in the ST group. The onset time of tourniquet pain, time to reach to maximumtourniquet pain and the amount of fentanyl consumption were compared between the two groups.Results: No significant difference was seen in demographic characteristics. The onset time of tourniquet pain (VAS=1)in the ST group (26.9±13.2 min) was longer than that of the DT group (13.8±4.8 min) (P<0.0001). The median of time toreach to maximum tourniquet pain (VAS>3) in DT and ST groups were 25 and 40 minutes, respectively; indicating thatthe patients in ST group reached to pain level at a significantly later time (P<0.0001). The total opioid consumption inthe DT group (61μg) was significantly lower than the ST group (102μg) (P<0.0001); however, both groups were similarregarding fentanyl consumption before 40 minutes of surgeries.Conclusion: It seems that in upper limb orthopedic surgeries with less than 40-minute duration, a single tourniquetmay serve as a proper alternative opposed to the conventional double tourniquet technique.

Item Type: Article
Subjects: WE Musculoskeletal system
WO Surgery
Divisions: Journals > Archives of Bone & Joint Surgery
Depositing User: abjs abjs
Date Deposited: 27 Jan 2018 13:52
Last Modified: 27 Jan 2018 13:52
URI: http://eprints.mums.ac.ir/id/eprint/9126

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