Procedures under tourniquet

Wong, Silky; Irwin, Michael G.

doi:10.1016/j.mpaic.2018.01.007

Cited by 3 publications

(2 citation statements)

References 7 publications

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“…The outcome showed a total of 27 (21.26%) cases bled after tourniquet deflation. Another report revealed that an increase in total blood loss and operation time occurred after early tourniquet release (36). Unnecessary blood loss probably aggravated the poor calcaneal blood supply, resulting in an unfavorable prognosis.…”

Section: Discussionmentioning

confidence: 99%

The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases

Huang¹,

Guo²,

Zhu³

2021

Ann Palliat Med

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Background: To analyze the epidemiology and features of calcaneus osteomyelitis following open reduction and internal fixation (ORIF) after closed calcaneus fracture.Methods: We retrospectively analyzed 127 cases who were diagnosed with calcaneal osteomyelitis following ORIF via the extended lateral "L-shaped" approach after closed calcaneus fracture between March 2016 and August 2019 in our hospital. We analyzed participant demographics including gender, age, body mass index (BMI), trauma mechanism, Sanders classification, co-morbidity, time between initial injury and surgery, operating time, soft tissue stripping tools, tourniquet pressure, bone grafting option, internal fixation option, presence of bleeding after tourniquet deflation, and drainage option.Results: The majority of cases (n=127) were male (4.5 times more than female gender), at a ratio of 4.47:1.Falling from height was the main trauma mechanism (79.53%), followed by traffic accident (14.17%), and jumping (6.3%). A total of 51 cases (40.16%) were left-side fractures, and 76 (59.84%) were right-sided.According to the Sanders classification, 12 cases were type II (9.45%), 61 cases were type III (48.03%), and 54 cases were type IV (42.52%). There were 25 participants with the co-morbidity of type 2 diabetes mellitus (19.69%), 7 with hypertension (5.51%), and 1 case each of psoriasis and sicca syndrome (0.8%). The mean time to surgery was 4.7 days (4-9 days), and 123 participants (96.85%) were treated within 7 days. The mean operating time was 102.1 min (75-135 min). Forty-four participants (34.65%) received the conventional scalpel and 83 participants (65.35%) the electric scalpel during soft tissue stripping intraoperatively. The mean tourniquet pressure was 432.3 mmHg (350-550 mmHg). Autologous bone grafting was observed in 6 cases (4.72%), allograft bone grafting in 11 cases (8.67%), and OsteoSet grafting in 7 cases (5.51%).A locking plate was used in 114 cases (89.76) while anatomical plate in 13 cases (10.24%). A total of 27 participants (21.26%) bled after tourniquet deflation. Drainage tubes were applied in 30 participants (23.62%) while rubber drainage strips in 5 participants (3.94%).Conclusions: Young males dominated the calcaneus osteomyelitis following traumatic calcaneus fracture cohort in this study. A fall from height was the most frequent trauma mechanism. The presence of severe calcaneus fracture, Sanders type III (48.03%) and type IV (42.52%), were the common fracture types in this population group.

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Section: Discussionmentioning

confidence: 99%

The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases

Huang¹,

Guo²,

Zhu³

2021

Ann Palliat Med

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“…They are thought to reduce intra-operative bleeding, improve surgical field of view and reduce surgical time [5][6][7]. However, by compressing the local tissues a tourniquet can cause venous stasis and ischaemia [8][9][10] which may increase the risk of venous thromboembolism, neurovascular injury, fracture non-union and wound complications including infection [10][11][12][13][14][15]. A tourniquet may also cause pain both intra and post-operatively, which may require increasing the depth of anaesthesia and higher doses of analgesia, respectively [16].…”

Section: Introductionmentioning

confidence: 99%

The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis

Farhan-Alanie

Dhaif

Trompeter

et al. 2021

Eur J Orthop Surg Traumatol

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Purpose Tourniquet use in lower limb fracture surgery may reduce intra-operative bleeding, improve surgical field of view and reduce length of procedure. However, tourniquets may result in pain and the production of harmful metabolites cause complications or affect functional outcomes. This systematic review aimed to compare outcomes following lower limb fracture surgery performed with or without tourniquet. Methods We searched databases for RCTs comparing lower limb fracture surgery performed with versus without tourniquet reporting on outcomes pain, physical function, health-related quality of life, complications, cognitive function, blood loss, length of stay, length of procedure, swelling, time to union, surgical field of view, volume of anaesthetic agent, biochemical markers of inflammation and injury, and electrolyte and acid–base balance. Random-effects meta-analysis was performed. PROSPERO ID CRD42020209310. Results Six RCTs enabled inclusion of 552 procedures. Pooled analysis demonstrated that tourniquet use reduced length of procedure by 6 minutes (95% CI −10.12 to −1.87; p < 0.010). We were unable to exclude increased harms from tourniquet use. Pooled analysis showed post-operative pain score was higher in tourniquet group by 12.88 on 100-point scale (95% CI −1.25–27.02; p = 0.070). Risk differences for wound infection, deep venous thrombosis and re-operation were 0.06 (95% CI −0.00–0.12; p = 0.070), 0.05 (95% CI −0.02–0.11; p = 0.150) and 0.03 (95% CI -0.03–0.09; p = 0.340). Conclusion Tourniquet use was associated with a reduced length of procedure. It is possible that tourniquets also increase incidence of important complications, but the data are too sparse to draw firm conclusions. Methodological weaknesses of the included RCTs prevent any solid conclusions being drawn for outcomes investigated. Further studies are required to address these limitations.

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Effect of intravenous regional anesthesia with spinal block on foot surgeries: A double-blinded randomized clinical trial

Seifi

Amri

Hasannasab

et al. 2021

Koomesh

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Introduction: Intravenous regional anesthesia is a simple and reliable method for surgeries of the lower extremities. The purpose of this study was to compare the effect of regional intravenous anesthesia with spinal anesthesia on foot surgeries.Materials and Methods: This study was conducted as a randomized clinical trial on 60 patients undergoing foot surgery in two similar groups. In this account, the intervention group received intravenous regional anesthesia with 40 mililitre of lidocaine (0.5%) and the control group underwent spinal anesthesia with marcaine (0.5%). Duration of analgesia, duration of postoperative analgesia after opening the tourniquet, recovery time, postoperative pain intensity based on Visual Analogue Scale (VAS), blood pressure, heart rate during the surgery and recovery period, and other complications such as nausea, vomiting and headache were assessed in both groups.Results: The two groups did not differ in age and sex. The mean duration of analgesia in the spinal group was 121.13±17.30 minutes and in the intravenous anesthesia group was 49.50±5.14 minutes (P<0.001). The mean duration of analgesia after opening the tourniquet was 72.17± 15.29 minutes in the control group and 11.17± 6.22 minutes in the intervention group (P<0.001). The mean recovery time in the control group was 26.83± 4.82 and in the intervention group was 13.10±3.20 min (P<0.001). One hour postoperative pain score was 2.3 ± 0.31 in the control group and 7.1± 0.20 in the intervention group (P<0.001). Hypotension, bradycardia, nausea and vomiting, dizziness, and headache were more incidental in the spinal group than in the intravenous anesthesia group (P<0.001). Conclusion:In short-term foot surgeries, intravenous regional anesthesia is more appropriate than intra-spinal.

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Procedures under tourniquet

Cited by 3 publications

References 7 publications

The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases

The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases

The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis

Effect of intravenous regional anesthesia with spinal block on foot surgeries: A double-blinded randomized clinical trial

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