Comparison of the Effect of Emla Cream, Subcutaneous Ring Anaesthesia and a Double Cuff Technique in the Prevention of Tourniquet Pain

Tsai, Yu‐Chuan; Lai, Y.-Y.; Chang, Chia Ling

doi:10.1097/00132586-199312000-00010

Cited by 3 publications

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“…The expansion of the receptive fields of primary proximal nociceptors inherent to the tourniquet may explain the relative resistance of this pain to an otherwise adequate level of anaesthesia. Skin could contribute significantly to the superficial component of tourniquet pain [16, 17]. Muscle pain could also play a part in tourniquet pain during inflation and after tourniquet release [18], metabolic changes have, however, shown significant correlation with tourniquet time, but not with tourniquet pressure [19].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2000

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2000

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“…Tsai YC et al, compared EMLA cream, subcutaneous ring anesthesia and double cuff technique in the prevention of tourniquet pain and concluded double cuff technique to be most effective. 26 The peripheral perineural injection of morphine for chronic intractable pain was found to produce local analgesia without the use local anaesthetic and its duration of action was found to be longer than that of systemic morphine and that of bupivacine. 27 Contrary to the traditional view that opioid antinociception takes place exclusively within central nervous system, there are peripheral opioid receptors that mediate analgesia, when activated by exogenous opioid agonists applied in the vicinity.…”

Section: Discussionmentioning

confidence: 99%

Comparative Evaluation of Efficacy of Plain Lignocaine 0.5%(3mg/ kg) with Lignocaine 0.5%(3mg/kg) + Buprenorphine (3μg/kg) in IV Regional Anaesthesia

Kumar¹,

Babu²,

Prasad³

et al. 2018

IJCMR

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Introduction:The main objective of the anaesthesiologist is to provide analgesia for surgery. Even though general anaesthesia was the earliest technique adopted to provide analgesia for surgery, the search for an alternative was made in order to overcome the problems and complications related to situations like `full stomach', in emergency surgeries. This Study aimed to evaluate the usefulness of adding an opioid analgesic, Buprenorphine 3μg/kg to 0.5% xylocaine 3 mg/kg (0.6 ml/ kg) in intravenous regional anaesthesia (Holmes' modification of Bier's Block) for forearm and hand surgeries in providing postoperative analgesia without increased incidence of side effects and complications. Material and methods: This clinical study was conducted for a period of 2 years (2002 -2003) at SV Medical college, SVRRGGH, Tirupati. 50 patients of ASA Grade -I and II of either sex undergoing upper limb (forearm and hand) surgery under intravenous regional anaesthesia, were randomly assigned to one of the 2 groups (25 each). Patients in Group -A received IVRA with Lignocaine 0.5% 3 mg/kg (0.6 ml/kg) and those in Group -B received IVRA with Lignocaine 0.5% 3 mg/kg (0.6 ml/kg) and 3μg/kg Buprenorphine. Onset and recovery times of sensory blockade (as assessed by pinprick), onset and recovery times of motor blockade (as assessed by flexion and extension movements of wrist and fingers and hand grip), postoperative duration of analgesia (as assessed by numerical pain rating scale score) and tourniquet times were compared between the two groups by t -test. The incidence of complications (respiratory depression, nausea, vomiting etc.,) were also compared between the two groups by chi -square test . Results:The mean onset time (i.e., injection to analgesia time) of sensory blockade (analgesia) in Buprenorphine + Lignocaine group (Group-B) was considerably less (3.72 ± 1.48 minutes) compared to that in Lignocaine group (Group-A) (6.24 ± 1.94 minutes) and the difference was also statistically significant (t = 5.26; p<0.001). Postoperative duration of analgesia in Buprenorphine + Lignocaine group (Group-B) was considerably more prolonged (447.4 ± 57.9 minutes) compared to that in Lignocaine group (8.92 ± 2.69 minutes) and the difference was statistically significant (t= 37.83; p<0.001). The recovery time of sensory blockade and the onset and recovery times of motor blockade and the tourniquet times were comparable between the two groups and yielded no statistical significance. Amongst all the complications compared between the two groups in the post operative period , only the incidence of vomiting in Group-B (12 cases) was statistically significant (χ2 = 8.03; df = 1; p<0.01, s) .Conclusion: Intravenous regional anaesthesia with addition of Buprenorphine to Lignocaine results in early onset of analgesia, prolonged residual (postoperative) analgesia and is free from any significant side effects. , T Jamuna. Comparative evaluation of efficacy of plain lignocaine 0.5%(3mg/kg) with lignocaine 0.5%(3mg/kg) + buprenorphine (3µg/kg) in IV region...

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“…Two previous studies have shown that subcutaneous ring anaesthesia and EMLA both significantly reduce or prevent tourniquet pain in intravenous anaesthesia of the arm [6, 7]. Brachial plexus block achieved by the axillary approach does not sufficiently anaesthetise the inner portion of the upper arm, an area where usually the tourniquet is applied.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effect of EMLA and semicircular subcutaneous anaesthesia in the prevention of tourniquet pain during plexus block anaesthesia of the arm

Tschaikowsky¹,

Hemmerling

1998

Anaesthesia

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In 54 patients who were to undergo surgery of the upper extremity in plexus block anaesthesia the effect of 5 g EMLA (group E) on tourniquet pain was examined and compared with the effect of a semicircular subcutaneous anaesthesia using 10 ml 0.25% bupivacaine (group B) or 10 ml 1% mepivacaine (group M). Among the patients with satisfactory brachial plexus analgesia allowing for surgery (n = 51), the incidence of tourniquet pain was not significantly different between groups E, M and B. Notably, there was no significant difference in the time of tourniquet application. We conclude that topical application of EMLA is as effective as a semicircular subcutaneous anaesthesia with mepivacaine or bupivacaine in the prevention of tourniquet pain during brachial plexus anaesthesia.

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Comparison of the Effect of Emla Cream, Subcutaneous Ring Anaesthesia and a Double Cuff Technique in the Prevention of Tourniquet Pain

Cited by 3 publications

References 0 publications

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

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

Comparative Evaluation of Efficacy of Plain Lignocaine 0.5%(3mg/ kg) with Lignocaine 0.5%(3mg/kg) + Buprenorphine (3μg/kg) in IV Regional Anaesthesia

Comparison of the effect of EMLA and semicircular subcutaneous anaesthesia in the prevention of tourniquet pain during plexus block anaesthesia of the arm

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