Abstract
Background: Pneumatic arterial tourniquet is a very commonly used technique in limb surgeries to provide bloodless field to facilitate dissection and decrease blood loss. However, arterial tourniquet has many deleterious effects including hemodynamic changes, serum lactate and potassium level changes and tourniquet-induced pain which sometimes can be severe and intolerable. Aim of the study: To evaluate the effect of different regional blocks: femoral-sciatic, spinal and epidural blocks on serum lactate and potassium levels and the degree of arterial tourniquet-induced pain in patients undergoing lower limb orthopedic surgeries. Methods: 60 patients underwent lower limb orthopedic surgery with application of tourniquet for duration not more than 90 minutes. Patients were assigned randomly to one of three groups (20 each) Group I had sciatic-femoral block, Group II: patients had spinal anesthesia and Group III: patients had epidural anesthesia. Intraoperative hemodynamics, changes in serum potassium and lactate levels and tourniquet pain after tourniquet inflation & deflation, were recorded. Results: There was no statistically significant difference among the three groups regarding tourniquet pain after tourniquet inflation (p = 0.872) and deflation (p = 0.902), and regarding serum levels changes of potassium (p = 0.067) and lactate (p = 0.051). However, each group showed statistically significant increase in post deflation tourniquet pain (p = 0.003, 0.002, 0.003, in groups F, S, E respectively) and serum potassium (p = 0.004, 0.006, 0.000, in groups F, S, E respectively) and lactate levels (p = 0.004, 0.000, 0.000, in groups F, S, E respectively) when compared to the pre-deflation values, and the increase was directly proportional to the duration of tourniquet. Conclusion: the three different types of anesthesia (femoral-sciatic, spinal and epidural block) have the same effect on serum lactate and potassium levels and the degree of tourniquet pain, which were related to the duration of tourniquet inflation.
Highlights
Pneumatic tourniquets are widely used in limb surgeries to provide a bloodless field and to facilitate surgical dissection
Conclusion: the three different types of anesthesia have the same effect on serum lactate and potassium levels and the degree of tourniquet pain, which were related to the duration of tourniquet inflation
This study is to evaluate the effect of different regional blocks: femor-sciatic, spinal and epidural blocks on the arterial tourniquet-induced metabolic chnges and pain in patients undergoing lower limb orthopedic surgeries
Summary
Pneumatic tourniquets are widely used in limb surgeries to provide a bloodless field and to facilitate surgical dissection. It is important to appreciate their potential complications, e.g., tourniquet pain, limb ischemia, nerve injury and reperfusion injury, which may be minimized by understanding the proper technique of tourniquet, careful patient evaluation to exclude contraindications and by using modern pneumatic tourniquets which are designed to minimize the incidence of these potential complications [1]. Many theories state that tourniquet pain is predominantly mediated by unmyelinated, slowly conducting C-fibres which are affected to a less extent by the compression of tourniquet inflation than larger fibres [8]. This randomized control study (RCT) was designed to assess the effect of different regional anesthetic techniques; combined femoral-sciatic block, spinal block & epidural block, on arterial tourniquet consequences. The secondary outcome variables were intraoperative hemodynamic changes (blood pressure and heart rate) during applying arterial tourniquet
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