Tourniquet inflation during arthroscopic knee ligament surgery does not increase postoperative pain

Canadian Journal of Anaesthesia - Tập 46 - Trang 925-929 - 1999
Jon Hooper1, Ola P. Rosaeg1, Barbara Krepski1, Donald H. Johnson1,2
1Department of Anesthesiology, The Ottawa Hospital-Civic Campus, Ottawa, Canada
2Division of Orthopedic Surgery, The Ottawa Hospital-Civic Campus, Ottawa, Canada

Tóm tắt

A double-blind clinical trial was conducted to determine the effect of inflation of a thigh tourniquet during anterior cruciate ligament repair on arthroscopic visibility, duration of procedure, postoperative pain and opioid consumption. Thirty patients were randomly allocated into two groups; Group I had the thigh tourniquet inflated during surgery whereas the tourniquet was not inflated in Group II patients. All patients received standardized general anesthesia and postoperative pain management. Supplemental analgesia was provided withiv morphine via a patient-controlled analgesia (PCA) apparatus. Verbal pain rating scores (0–10) were obtained after surgery. Arthroscopic visibility was impaired in Group II patients (P < 0.0001), but this was ameliorated by increased irrigation flow or addition of epinephrine. Duration of surgery was similar in both groups. There was no difference between groups in postoperative morphine consumption (9.8 ± 7.1 mg in Group Ivs 11.4 ± 10.2 mg in Group II) or in postoperative pain scores between groups. Inflation of a thigh tourniquet did not result in increased pain or opioid consumption after arthroscopic ACL surgery. Arthroscopic visibility was somewhat impaired in some patients without the use of tourniquet. Finally, the duration of the surgical procedure was not increased in patients where the tourniquet was not inflated during the ACL repair.

Tài liệu tham khảo

Estebe JP, Mallédant Y. The pneumatic tourniquet in surgery of the limbs. Ann Fr Anesth Réanim 1996; 15: 162–78. Gutin B, Warren R, Wickiewicz T, O’Brien S, Altchek D, Kroll M. Does tourniquet use during anterior cruciate ligament surgery interfere with postsurgical recovery of function? A review of the literature. Arthroscopy 1991; 7: 52–6. Daniel DM, Lumkong G, Stone ML, Pedowitz RA. Effects of tourniquet use in anterior cruciate ligament reconstruction. Arthroscopy 1995; 11: 307–11. Strichartz G, Zimmerman M. An explanation for pain originating from tourniquets during regional anesthesia. Reg Anesth 1984; 9: 44–5. Hagenouw RRPM, Bridenbaugh PO, van Egmond J, Stuebing R. Tourniquet pain: a volunteer study. Anesth Analg 1986; 65: 1175–80. Crews JC, Sehlhorst CS. Response to maintenance of tourniquet inflation in a primate model. Reg Anesth 1991; 16: 195–8. MacIver MB, Tanelian DL. Activation of C fibers by metabolic perturbations associated with tourniquet ischemia. Anesthesiology 1992; 76: 617–23. Crews JC, Cahall M, Behbehani MM. The neurophysiologic mechanisms of tourniquet pain. The activity of neurons in the rostroventral medulla in the rat. Anesthesiology 1994; 81: 730–6. Coderre TJ, Katz J, Vaccarino AL, Melzack R. Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain 1993; 52: 259–85. Silver R, de la Garza J, Rang M, Koreska J. Limb swelling after release of a tourniquet. Clin Orthop 1986; 206: 86–9. Middleton RWD, Varian JP. Tourniquet paralysis. Aust NZ J Surg 1974; 44: 124–8. Dobner J, Nitz A. Postmeniscectomy tourniquet palsy and functional sequelae. Am J Sports Med 1982; 10: 211–4. Jacobson MD, Pedowitz RA, Oyama BK, Tryon B, Gershuni DH. Muscle functional deficits after tourniquet ischemia. Am J Sports Med 1994; 22: 372–7. Kohro S, Yamakage M, Arakawa J, Kotaki M, Omote T, Namiki A. Surgical/tourniquet pain accelerates blood coagulability but not fibrinolysis. Br J Anaesth 1998; 80: 460–3. Stulberg BN, Insall JN, Williams GW, Ghelman B, Deepvein thrombosis following total knee replacement. An analysis of six hundred and thirty-eight arthroplasties. J Bone Joint Surg [Am] 1984; 66-A: 194–201. Block EC. Hyperthermia resulting from tourniquet application in children. Ann R Coll Surg 1986; 68: 193–4. O’Leary AM, Veall G, Butler P, Anderson GH. Acute pulmonary oedema after tourniquet release (Letter). Can J Anaesth 1990; 37: 826–7. Gielen M. Cardiac arrest after tourniquet release. (Letter) Can J Anaesth 1991; 38: 541. Abdel-Salam A, Eyres KS. Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg [Br] 1995; 77-B: 250–3. Ömeroglu H, Günel U, Biçimuglu A, Tabak AY, Uçaner A, Güney Ö. The relationship between the use of tourniquet and the intensity of postoperative pain in surgically treated malleolar fractures. Foot Ankle Int 1997; 18: 798–802. Ringrose NH, Cross MJ. Femoral nerve block in knee joint surgery. Am J Sports Med 1984; 12: 398–402. Moote C. Efficacy of nonsteroidal anti-inflammatory drugs in the management of postoperative pain. Drugs 1992; 44(Suppl 5): 14–30. Allen GC, St. Amand MA, Lui ACP, Johnson DH, Lindsay MP. Postarthroscopy analgesia with intraarticular bupivacaine/morphine. Anesthesiology 1993; 79: 475–80. Whitelaw GP, DeMuth KA, Demos HA, Schepsis A, Jacques E. The use of the cryo/cuff versus ice and elastic wrap in the postoperative care of knee arthroscopy patients. Am J Knee Surg 1995; 8: 28–31.