Randomised controlled trial of tourniquet associated pain generated in lower limb after exsanguination by Esmarch bandage versus limb elevation

Abstract

Background Tourniquets are common adjuncts in the operating theatre but can be associated with post-operative pain. This study was designed to compare what effect pre-tourniquet Esmarch bandage exsanguination has on pain, compared to pre-tourniquet exsanguination by elevation alone. Methods 52 volunteers (104 lower limbs) were included in this study with each volunteer acted as their own matched control. The primary outcome was pain level, measured in both legs simultaneously using visual analogue scale every 2 minutes for 20 minutes of tourniquet inflation and every minute after deflation. Secondary outcomes were pain difference, cumulative pain score, time of recovery and blood pressure during occlusion and release time. Results There was no statistically significant difference in cumulative pain score between legs regardless dominance, site of investigation and point of time. There was no difference in cumulative pain scores between Esmarch and elevation under inflation (50.6, SD 17.0 vs 51.7, SD 16.8, p = 0.87) or deflation (23.4, SD 14.8 vs 24.1, SD 14.9, p = 0.94). Time to full recovery of the lower limb was the same for both groups — 7.6 minutes (SD 2.1min, p = 0.80). Conclusion Previous studies describe a positive effect on pain when Esmarch bandage was used prior to tourniquet inflation for upper limb. Using a high level of evidence, we could not prove the same benefit from Esmarch when it was used on lower limbs during inflation of tourniquet, nor after release. These two techniques yield similar pain profiles, and patient factors need to be considered when deciding between elevation and Esmarch bandage.