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. 2018 Dec 4;10(12):e3678.
doi: 10.7759/cureus.3678.

Postoperative Tourniquet Pain in Patients Undergoing Foot and Ankle Surgery

Promil Kukreja  1 , Eva Lehtonen  2 , Martim C Pinto  3 , Harshadkumar A Patel  3 , Haley M McKissack  4 , Ashish Shah  4
Affiliations

Postoperative Tourniquet Pain in Patients Undergoing Foot and Ankle Surgery

Promil Kukreja et al. Cureus. .

Abstract

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.

Keywords: foot and ankle surgery; pain; tourniquet pressure; tourniquet time.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Pneumatic tourniquet pressures greater than systolic blood pressure used during foot and ankle surgery at UAB Highlands Hospital
UAB: University of Alabama at Birmingham
Figure 2
Figure 2. Positive linear correlation between tourniquet time and PACU length of stay
PACU: post-anesthesia care unit
See this image and copyright information in PMC

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