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Journal of the American Academy of... Feb 2022In distal upper extremity surgeries, there can be a choice to use an upper arm or forearm tourniquet. This study examines discomfort and tolerance in healthy volunteers... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In distal upper extremity surgeries, there can be a choice to use an upper arm or forearm tourniquet. This study examines discomfort and tolerance in healthy volunteers to determine whether one is more comfortable.
METHODS
Forty healthy, study participants were randomized to an upper extremity laterality and site. Tourniquets were inflated to 100 mm Hg over systolic blood pressure. Participants experienced an upper arm and a forearm tourniquet sequentially. Visual analog scores (VAS) were recorded at 2-minute intervals. Time until request and VAS at tourniquet deflation were recorded. Time until the complete resolution of paresthesias was also recorded. Participants subjectively stated which tourniquet felt more comfortable.
RESULTS
Tourniquets were inflated longer on the forearm than the upper arm (mean 16.1 minutes versus 12.2 minutes; P < 0.0001). VAS at tourniquet removal was not different between the sites (means 7.3 and 7.3) (P = 0.839). Time until paresthesia resolution after the tourniquet was deflated was not different (means 8.1 and 7.7 minutes) (P = 0.675). Time until paresthesia resolution was proportional to tourniquet inflation time for both sites (regression coefficient 0.41; P < 0.00001). Participants found the forearm more comfortable (95% confidence interval, 0.63 to 0.92).
CONCLUSION
Forearm placement allows the tourniquet to be inflated for an average of 4 minutes longer. Forearm tourniquet is subjectively more comfortable.
Topics: Arm; Forearm; Humans; Paresthesia; Tourniquets; Upper Extremity
PubMed: 35167505
DOI: 10.5435/JAAOSGlobal-D-21-00229 -
Asian Journal of Andrology May 2013Tourniquets are commonly used in penile surgery to achieve a bloodless operating field or produce artificial erections intraoperatively. Several techniques have been... (Review)
Review
Tourniquets are commonly used in penile surgery to achieve a bloodless operating field or produce artificial erections intraoperatively. Several techniques have been described, but there is a paucity of data and a lack of guidelines to direct their safe use. In penile surgery, it is the local rather than systemic effects of tourniquet use that are the main concern. Tourniquet time should be kept to a minimum, as the limited data available suggests that reperfusion injury can occur even after short periods of ischaemia. High risk groups such as diabetics and arteriopaths are at particular risk. Further studies are needed to determine safe tourniquet times and pressures.
Topics: Humans; Ischemia; Male; Penis; Practice Guidelines as Topic; Reperfusion Injury; Time Factors; Tourniquets
PubMed: 23542140
DOI: 10.1038/aja.2012.164 -
Chinese Journal of Traumatology =... Sep 2021The use of tourniquet in orthopedic surgery facilitates operation by establishing a bloodless surgical field. However, many complications following the use of... (Observational Study)
Observational Study
PURPOSE
The use of tourniquet in orthopedic surgery facilitates operation by establishing a bloodless surgical field. However, many complications following the use of tourniquets have been reported. Tourniquet pain is the most common complication. This study aimed to find the actual incidence of pain associated with tourniquet use in orthopedic surgery and the various factors.
METHODS
It is a prospective observational study conducted on 132 consecutive cases. Patients aged 18-70 years with musculoskeletal problems of the forearm and leg requiring surgery were included in the study. Patients with open injuries or contraindications such as diabetes mellitus, compromised circulatory states, neurological deficit, compartment syndrome and unable to give informed consent were excluded. The parameters assessed included duration of tourniquet use, tourniquet pressure, type of anesthesia, any interval release of the tourniquet and reapplication after a reperfusion period, whether upper or lower limb surgery, severity of tourniquet pain, timing of tourniquet release and complications. Chi-square and non-parametric Mann-Whitney U test were used for data analysis.
RESULTS
In upper limb surgeries, if duration of surgery was less than 60 min, 14 (51.8%) cases experienced tourniquet pain and 13 (48.1%) had no pain, and if duration of surgery was more than 60 min, 24 (60.0%) had pain and 16 (40.0%) experienced no pain. In lower limb surgeries if duration of surgery was less than 60 min, 2 (7.7%) experienced pain and 24 (92.3%) had no pain, and if duration of surgery was more than 60 min, 14 (35.8%) experienced pain and 25 (64.8%) had no pain. Degree of tourniquet pain increases with the duration of surgery. Statistically, there was significant association between tourniquet inflation time and tourniquet pain in both upper and lower limbs (p = 0.034 and 0.024, respectively) CONCLUSION: Incidence of tourniquet pain was in direct proportion to the duration of tourniquet use and was higher in cases with regional anesthesia. Other risk factors assessed including tourniquet pressure, upper or lower limb surgery, tourniquet release time and interval had no significant contribution to the incidence or severity of tourniquet pain.
Topics: Humans; Incidence; Orthopedic Procedures; Pain; Pain Measurement; Tourniquets
PubMed: 34281783
DOI: 10.1016/j.cjtee.2021.05.002 -
Physiology (Bethesda, Md.) May 2022Saving lives of wounded military warfighters often depends on the ability to resolve or mitigate the pathophysiology of hemorrhage, specifically diminished oxygen... (Review)
Review
Saving lives of wounded military warfighters often depends on the ability to resolve or mitigate the pathophysiology of hemorrhage, specifically diminished oxygen delivery to vital organs that leads to multiorgan failure and death. However, caring for hemorrhaging patients on the battlefield presents unique challenges that extend beyond applying a tourniquet and giving a blood transfusion, especially when battlefield care must be provided for a prolonged period. This review describes these challenges and potential strategies for treating hemorrhage on the battlefield in a prolonged casualty care situation.
Topics: Hemorrhage; Humans; Military Medicine; Military Personnel; Tourniquets; Warfare
PubMed: 35001653
DOI: 10.1152/physiol.00028.2021 -
Revista Do Colegio Brasileiro de... 2020to present a low-cost model for bleeding control training with the use of a tourniquet and the results of the training evaluation.
OBJECTIVE
to present a low-cost model for bleeding control training with the use of a tourniquet and the results of the training evaluation.
METHOD
low-cost and easy-to-purchase materials, such as upholstery foam, ethylene-vinyl acetate (EVA) sheet, plastic propulsion pump, saline container, water, school paint, serum equipment, rubber tubing for tourniquet, and a leg and an arm of a ghost mannequin, were used. In the model assembly, we created an active bleeding simulation system, which could only be controlled with the correct application of the tourniquet. The model was submitted to professional and academic evaluation.
RESULTS
the model was similar to human anatomy, proved to be practical in the bleeding control training with the use of a tourniquet, and had low cost.
CONCLUSION
the model for bleeding control training had excellent acceptability, was considered viable for educational purposes of tourniquet use, and had low cost.
Topics: Adult; Equipment Design; Female; Health Personnel; Hemorrhage; Humans; Male; Simulation Training; Surveys and Questionnaires; Tourniquets
PubMed: 31967244
DOI: 10.1590/0100-6991e-20192324 -
Hand (New York, N.Y.) Jul 2019Ganglion cysts are the most common type of soft tissue tumors of the hand. In the pediatric population, monitoring may be appropriate unless cysts are painful,... (Review)
Review
Ganglion cysts are the most common type of soft tissue tumors of the hand. In the pediatric population, monitoring may be appropriate unless cysts are painful, interfering with range of motion or parental concerns exist. Reported recurrence rates after surgical removal of pediatric ganglion cysts vary widely in the literature. Notably, recurrence rates are higher for children than adults, ranging from as low as 6% to as high as 35%. A retrospective review was performed of a single pediatric hand surgeon's patients undergoing excision of primary and recurrent ganglion cysts from 2010 to 2015. Variables measured included patient age at diagnosis of ganglion cyst, time to presentation, location of cyst, hand dominance, previous therapy, previous surgery, length of surgery, tourniquet time, length of follow-up, any associated complications, and recurrence of cyst. Ninety-six patients were identified with an average age of diagnosis 10.2 years. Indications for surgery: 95.8% for pain or decreased range of motion, 4.2% for cosmetic or parental concern. About 75% of the cysts were dorsally located, with the remaining 24.2% being volar. A total of 5 (5.3%) recurrences were recorded. Tourniquet time was on average 9.8 minutes longer for cases that resulted in recurrence. Multivariate analysis of the data demonstrated a 25% increased risk of recurrence with patients who had a previous aspiration. This is a retrospective review of a single pediatric hand surgeon's outcomes of pediatric wrist ganglion cysts. Our recurrence rate of 5.3% is low for a pediatric population indicating potential merit in this surgeon's operative and postoperative techniques. We demonstrate significantly increased rates of recurrence when a cyst had been previously aspirated, possibly indicating scarring and disruption of planes resulting in difficult dissection, increased tourniquet times, and incomplete excision.
Topics: Aftercare; Biopsy, Fine-Needle; Child; Female; Ganglion Cysts; Hand; Humans; Male; Operative Time; Pain; Range of Motion, Articular; Recurrence; Retrospective Studies; Soft Tissue Neoplasms; Tourniquets; Treatment Outcome; Wrist
PubMed: 29310457
DOI: 10.1177/1558944717751195 -
British Journal of Hospital Medicine... Jan 2022Wide awake local anaesthesia no tourniquet, also known as WALANT, is the practice of performing surgery under local anaesthetic in the absence of a tourniquet. This... (Review)
Review
Wide awake local anaesthesia no tourniquet, also known as WALANT, is the practice of performing surgery under local anaesthetic in the absence of a tourniquet. This technique uses the vasoconstrictive effects of adrenaline and the local anaesthetic effects of lignocaine to establish a Bier block with haemostatic control. Permitting active patient participation intraoperatively, wide awake local anaesthesia no tourniquet surgery improves patient compliance with rehabilitation and yields higher patient satisfaction. With reduced cost and equipment requirements, this method improves accessibility for patients and productivity for healthcare institutions. This is of particular benefit within the current COVID-19 climate, as wide awake local anaesthesia no tourniquet technique provides a means of overcoming restrictions to theatre access and anaesthetic support. This review delves into the current uses of wide awake local anaesthesia no tourniquet surgery, outlining the initial conception of the practice by Canadian surgeons. The advantages and disadvantages are considered, and potential future applications of this technique are discussed.
Topics: Anesthesia, Local; Anesthetics, Local; COVID-19; Canada; Epinephrine; Humans; SARS-CoV-2; Tourniquets
PubMed: 35129384
DOI: 10.12968/hmed.2021.0383 -
Sensors (Basel, Switzerland) Feb 2022Uncontrolled hemorrhage remains a leading cause of death in both emergency and military medicine. Tourniquets are essential to stopping hemorrhage in these scenarios,...
Uncontrolled hemorrhage remains a leading cause of death in both emergency and military medicine. Tourniquets are essential to stopping hemorrhage in these scenarios, but they suffer from subjective, inconsistent application. Here, we demonstrate how tourniquet application can be automated using sensors and computer algorithms. The auto-tourniquet self-tightens until blood pressure oscillations are no longer registered by the pressure sensor connected to the pneumatic pressure cuff. The auto-tourniquet's performance in stopping the bleed was comparable to manual tourniquet application, but the time required to fully occlude the bleed was longer. Application of the tourniquet was significantly smoother, and less variable, for the automatic tourniquet compared to manual tourniquet application. This proof-of-concept study highlights how automated tourniquets can be integrated with sensors to provide a much more consistent application and use compared to manual application, even in controlled, low stress testing conditions. Future work will investigate different sensors and tourniquets to improve the application time and repeatability.
Topics: Hemorrhage; Humans; Tourniquets
PubMed: 35161867
DOI: 10.3390/s22031122 -
Oxidative Medicine and Cellular... 2018Ischemia and reperfusion (I/R) injury induced by tourniquet (TQ) application leads to the release of both oxygen free radicals and inflammatory cytokines. The skeletal... (Review)
Review
Ischemia and reperfusion (I/R) injury induced by tourniquet (TQ) application leads to the release of both oxygen free radicals and inflammatory cytokines. The skeletal muscle I/R may contribute to local skeletal muscle and remote organ damage affecting outcomes after total knee arthroplasty (TKA). The aim of the study is to summarize the current findings associated with I/R injury following TKA using a thigh TQ, which include cellular alterations and protective therapeutic interventions. The PubMed database was searched using the keywords "ischemia reperfusion injury," "oxidative stress," "tourniquet," and "knee arthroplasty." The search was limited to research articles published in the English language. Twenty-eight clinical studies were included in this qualitative review. Skeletal muscle I/R reduces protein synthesis, increases protein degradation, and upregulates genes in cell stress pathways. The I/R of the lower extremity elevates local and systemic oxidative stress as well as inflammatory reactions and impairs renal function. Propofol reduces oxidative injury in this I/R model. Ischemic preconditioning (IPC) and vitamin C may prevent oxygen free radical production. However, a high dose of -acetylcysteine possibly induces kidney injury. In summary, TQ-related I/R during TKA leads to muscle protein metabolism alteration, endothelial dysfunction, oxidative stress, inflammatory response, and renal function disturbance. Propofol, IPC, and vitamin C show protective effects on oxidative and inflammatory markers. However, a relationship between biochemical parameters and postoperative clinical outcomes has not been validated.
Topics: Animals; Arthroplasty, Replacement, Knee; Biomarkers; Humans; Oxidative Stress; Reperfusion Injury; Tourniquets
PubMed: 30524661
DOI: 10.1155/2018/8087598 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Mar 2019The primary aim of this study was to compare the effects of a small-dose infusion of 2 antioxidant agents, ketamine and lidocaine, on ischemia-reperfusion injury (IRI)... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The primary aim of this study was to compare the effects of a small-dose infusion of 2 antioxidant agents, ketamine and lidocaine, on ischemia-reperfusion injury (IRI) in patients undergoing elective lower limb surgery. Ischemia-modified albumin (IMA), lactate, and blood gas levels were all measured and assessed.
METHODS
A total of 100 patients who underwent lower extremity surgery were randomized into 3 groups. After spinal anesthesia, the ketamine group (Group K, n=33) was given a ketamine infusion, a lidocaine infusion was administered to the lidocaine group (Group L, n=33), and in the control group (Group C), 0.9% a sodium chloride infusion was performed. Blood samples were obtained for IMA analysis before anesthetic administration (baseline), at 30 minutes of tourniquet inflation (ischemia), and 15 minutes after tourniquet deflation (reperfusion). Arterial blood gas measurements were determined before anesthetic administration and 15 minutes after tourniquet deflation.
RESULTS
The lactate and IMA levels at reperfusion were significantly lower in both the ketamine group and the lidocaine group when compared with the control group.
CONCLUSION
The administration of both ketamine and lidocaine infusions significantly decreased skeletal muscle IRI-related high lactate and IMA levels. These results suggest the possibility of the clinical application of ketamine or lidocaine infusions in cases of skeletal muscle-related IRI.
Topics: Adult; Biomarkers; Free Radicals; Humans; Ketamine; Lactates; Lidocaine; Lower Extremity; Reperfusion Injury; Serum Albumin, Human; Tourniquets
PubMed: 30892676
DOI: 10.5505/tjtes.2018.63439