Tourniquet use during ankle surgery leads to increased postoperative opioid use

Kruse, H.; Christensen, K. P.; Møller, Ann Merete; Gögenur, Ismail

doi:10.1016/j.jclinane.2015.03.034

Cited by 26 publications

(18 citation statements)

References 18 publications

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“…A large cohort study by Kruse and colleagues 17 retrospectively analyzed the effect of tourniquet use on postoperative pain and opioid consumption following ankle surgery. They concluded that tourniquets resulted in elevated pain severity scores, which corresponded to a significant increase in postoperative opioid use after controlling for confounders.…”

Section: Are the Results Valid?mentioning

confidence: 99%

Users’ guide to the surgical literature: how to assess an article using surrogate end points

Gallo

Eskicioglu

Braga

et al. 2017

cjs

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Phase 3 randomized controlled trials are the widely accepted gold standard through which treatment decisions are made, as they assess the efficacy of a novel treatment against the control on the relevant patient population. The effectiveness of the novel treatment should be derived by measuring patientimportant outcomes; however, to accurately assess these outcomes, clinical trials often require extensive patient follow-up and large sample sizes that can incur substantial expense. For this reason, investigators substitute surrogate end points to reduce the sample size and duration of a trial, ultimately reducing cost. The purpose of this article is to help surgeons appraise the surgical literature that use surrogate end points for patient-important outcomes. Summary DISCUSSIONS IN SURGERY

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Section: Are the Results Valid?mentioning

confidence: 99%

Users’ guide to the surgical literature: how to assess an article using surrogate end points

Gallo

Eskicioglu

Braga

et al. 2017

cjs

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show abstract

“…These findings are consistent with previous studies in the orthopedic literature. A retrospective review (N = 603) by Kruse et al comparing postoperative opioid use in first 24 hours in patients undergoing total knee replacement with and without the use of intraoperative tourniquet showed an increased tourniquet time was associated with increased opioid use, with every additional 10 minutes of tourniquet time leading to an additional 0.43 mg of opioid consumption [12]. This phenomenon may be mediated by ischemia and reperfusion injury following tourniquet use leading to higher postoperative pain and subsequently higher opioid use during the postoperative period [13][14].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Tourniquet Pain in Patients Undergoing Foot and Ankle Surgery

Kukreja

Lehtonen

Pinto

et al. 2018

Cureus

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Background Tourniquets are commonly used to reduce bleeding intraoperatively during orthopedic surgery. There are variable guidelines for ideal tourniquet pressure and duration; the practice of fixed, high tourniquet pressures remains common. The purpose of this study was to assess the correlation between excessive tourniquet pressure and duration and the incidence of tourniquet pain in foot and ankle surgery patients. Methods A retrospective cohort study was conducted on 128 patients who underwent foot and ankle surgery with tourniquet use. Baseline systolic blood pressure (SBP), tourniquet pressure and duration, intraoperative opioid consumption, post-anesthesia care unit (PACU) pain scores, PACU opioid consumption, and PACU length of stay (LOS) were collected. Linear regression analysis was used to test for the statistical correlation between the tourniquet pressure and duration and postoperative pain scores, narcotic use, and PACU LOS. Results A tourniquet pressure of 280 mmHg was used in 90% of the cases (N = 128). Only 2.5% of the patients had tourniquet pressures 100-150 mmHg above SBP. The mean tourniquet time was 107.5 minutes ± 39.8. Linear regression showed a significant positive correlation between tourniquet time and morphine equivalents used in the perioperative period (r = 0.410; p < 0.001) and the length of PACU stay (r = 0.250; p = 0.012). Conclusion Prolonged tourniquet times at high pressures, not based on limb occlusion pressure LOP, lead to increased pain and opioid use and prolonged PACU LOS. Basing tourniquet pressures on LOPs could likely improve the safety margin of the tourniquets; however, randomized clinical trials are needed.

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“…Other than missed bleeding sources and time pressure within the 2-hour ischaemia interval, various other negative effects of tourniquet use have been reported in the current literature. Kruse et al 34 reported an increased post-operative opioid use in a prospective cohort study of patients who received ankle surgery with a correlation between opioid use and intra-operative tourniquet time. In a randomised trial of patients receiving total knee arthroplasty (TKA) with or without tourniquet, Dennis et al 35 determined that there were no differences in range of motion and strength, with the exception of slightly lower quadriceps strength in the tourniquet group.…”

Section: Management Of Bone Defectsmentioning

confidence: 99%

Partial proximal tibia fractures

2017

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Partial tibial plateau fractures may occur as a consequence of either valgus or varus trauma combined with a rotational and axial compression component.High-energy trauma may result in a more complex and multi-fragmented fracture pattern, which occurs predominantly in young people. Conversely, a low-energy mechanism may lead to a pure depression fracture in the older population with weaker bone density.Pre-operative classification of these fractures, by Müller AO, Schatzker or novel CT-based methods, helps to understand the fracture pattern and choose the surgical approach and treatment strategy in accordance with estimated bone mineral density and the individual history of each patient.Non-operative treatment may be considered for non-displaced intra-articular fractures of the lateral tibial condyle. Intra-articular joint displacement ⩾ 2 mm, open fractures or fractures of the medial condyle should be reduced and fixed operatively. Autologous, allogenic and synthetic bone substitutes can be used to fill bone defects.A variety of minimally invasive approaches, temporary osteotomies and novel techniques (e.g. arthroscopically assisted reduction or ‘jail-type’ screw osteosynthesis) offer a range of choices for the individual and are potentially less invasive treatments.Rehabilitation protocols should be carefully planned according to the degree of stability achieved by internal fixation, bone mineral density and other patient-specific factors (age, compliance, mobility). To avoid stiffness, early functional mobilisation plays a major role in rehabilitation. In the elderly, low-energy trauma and impression fractures are indicators for the further screening and treatment of osteoporosis.Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160067. Originally published online at www.efortopenreviews.org

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Tourniquet use during ankle surgery leads to increased postoperative opioid use

Cited by 26 publications

References 18 publications

Users’ guide to the surgical literature: how to assess an article using surrogate end points

Users’ guide to the surgical literature: how to assess an article using surrogate end points

Postoperative Tourniquet Pain in Patients Undergoing Foot and Ankle Surgery

Partial proximal tibia fractures

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