Controlled Hypotension and Minimal Inflation Pressure: A New Approach for Pneumatic Tourniquet Application in Upper Limb Surgery

Tuncalı, Bahattin; Karcı, Ayşe; Bacakoglu, Abdul Kadir; Tuncali, Binnur Erdalkiran; Ekin, Atalay

doi:10.1213/01.ane.0000081660.97731.91

Cited by 39 publications

(26 citation statements)

References 16 publications

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“…Tourniquet pain, which is described as a dull and aching pain sensation, is a well-known limitation of IVRA. Skin compression 18 , tourniquet size 19 , inflation pressure 20 , and adjuvants in the LA solution 21 have been implicated as factors involved in tourniquet pain. Tourniquet pain is thought to be mediated by impulse propagation via small, unmyelinated, slow-conducting C fibers 21 .…”

Section: Discussionmentioning

confidence: 99%

The analgesic effect of nitroglycerin added to lidocaine on quality of intravenous regional anesthesia in patients undergoing elective forearm and hand surgery

Asadi

Mehri

2013

Acta Cir. Bras.

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PURPOSE:To evaluate the effect of nitroglycerine (NTG) on sensory and motor block onset and recovery time as well as the quality of tourniquet pain relief, when added to lidocaine (LID) for intravenous regional anesthesia in elective forearm and hand surgery. METHODS:A randomized double-blinded clinical trial was performed on 40 patients that were randomly allocated into two groups received lidocaine 3 mg/kg with NTG 200 µg or received only lidocaine 3 mg/kg as the control. RESULTS:There was no difference between the two study groups in hemodynamic parameters before tourniquet inflation, at any time after inflation and after its deflation. There was no difference in the mean of pain score over time between the two groups. The onset time of sensory and motor blockades was shorter in the group received both LID and NTG. The mean recovery time of sensory blockade was longer in the former group. The frequency of opioid injections was significantly lower in those who administered LID and NTG. CONCLUSION:The adjuvant drug of NTG when added to LID is effective in improving the overall quality of anesthesia, shortening onset time of both sensory and motor blockades, and stabling homodynamic parameters in hand and forearm surgery.

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Section: Discussionmentioning

confidence: 99%

The analgesic effect of nitroglycerin added to lidocaine on quality of intravenous regional anesthesia in patients undergoing elective forearm and hand surgery

Asadi

Mehri

2013

Acta Cir. Bras.

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“…Some authors have even advocated using controlled hypotension during anesthesia to decrease the tourniquet pressure. 18 The data available to date strongly suggest that tourniquet pressures of 250 mm Hg are more than sufficient in the lower extremity, and pressures of 200 mm Hg are enough in the upper extremity. Moreover, higher pressures lead to higher morbidity.…”

Section: Discussionmentioning

confidence: 99%

Tourniquet Cuff Pressure: The Gulf Between Science and Practice

Tejwani

Immerman²,

Achan³

et al. 2006

The Journal of Trauma: Injury, Infection, and Critical Care

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“…In brachial plexus block, anesthesia of the medial cutaneous nerves by a skin infiltration of local anesthetic at the root of the arm improved arm tourniquet tolerance [67]. Other factors such as tourniquet size, inflation pressure, and duration impact on patient discomfort [68][69][70][71]. Another mechanism of tourniquet pain is ischemia of underlying nerves and muscles.…”

Section: Recommendation Ementioning

confidence: 99%