Abstract
Background Tourniquets are commonly used to reduce bleeding intraoperatively during orthopedic surgery. There are variable guidelines for ideal tourniquet pressure and duration; the practice of fixed, high tourniquet pressures remains common. The purpose of this study was to assess the correlation between excessive tourniquet pressure and duration and the incidence of tourniquet pain in foot and ankle surgery patients.Methods A retrospective cohort study was conducted on 128 patients who underwent foot and ankle surgery with tourniquet use. Baseline systolic blood pressure (SBP), tourniquet pressure and duration, intraoperative opioid consumption, post-anesthesia care unit (PACU) pain scores, PACU opioid consumption, and PACU length of stay (LOS) were collected. Linear regression analysis was used to test for the statistical correlation between the tourniquet pressure and duration and postoperative pain scores, narcotic use, and PACU LOS.ResultsA tourniquet pressure of 280 mmHg was used in 90% of the cases (N = 128). Only 2.5% of the patients had tourniquet pressures 100-150 mmHg above SBP. The mean tourniquet time was 107.5 minutes ± 39.8. Linear regression showed a significant positive correlation between tourniquet time and morphine equivalents used in the perioperative period (r = 0.410; p < 0.001) and the length of PACU stay (r = 0.250; p = 0.012).Conclusion Prolonged tourniquet times at high pressures, not based on limb occlusion pressure LOP, lead to increased pain and opioid use and prolonged PACU LOS. Basing tourniquet pressures on LOPs could likely improve the safety margin of the tourniquets; however, randomized clinical trials are needed.
Highlights
The tourniquet is commonly used in orthopedic surgeries on the upper and lower extremities to reduce blood loss, improve visualization, and expedite the surgical procedure
Linear regression showed a significant positive correlation between tourniquet time and morphine equivalents used in the perioperative period (r = 0.410; p < 0.001) and the length of post-anesthesia care unit (PACU) stay ( r = 0.250; p = 0.012)
We excluded patients who had a history of daily opioid use of more than 30 mg oral morphine equivalents (OME) for more than 30 days, with the preexisting preoperative pain score greater than five out of 10 on the visual analog scale (VAS), underwent foot and ankle surgery without a regional nerve block, were deemed regional block failures by the regional anesthesia provider, did not have the peripheral nerve block type recorded, or underwent foot and ankle surgery without tourniquet use
Summary
The tourniquet is commonly used in orthopedic surgeries on the upper and lower extremities to reduce blood loss, improve visualization, and expedite the surgical procedure. Tourniquets have been associated with multiple local and systemic complications causing significant morbidity to patients. Patients who receive sufficient surgical block with regional anesthesia can still experience tourniquet pain postoperatively [1]. In a study involving awake patients, How to cite this article Kukreja P, Lehtonen E, Pinto M C, et al (December 04, 2018) Postoperative Tourniquet Pain in Patients Undergoing Foot and Ankle Surgery. A patient may complain of a dull, achy pain at the site of the tourniquet had been previously placed [7]. The purpose of this study was to assess the correlation between excessive tourniquet pressure and duration and the incidence of tourniquet pain in foot and ankle surgery patients
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