A Comparison between Single and Double Tourniquet Technique in Distal Upper Limb Orthopedic Surgeries with Intravenous Regional Anesthesia

Document Type : RESEARCH PAPER


1 Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran

2 Orthopedic Department, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran

3 Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran

4 Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran

5 Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran


Background: Several studies have put an effort to minimize the tourniquet pain and complications after conventional
double tourniquet intravenous regional anesthesia (IVRA). We expressed in our hypothesis that an upper arm single
wide tourniquet (ST) may serve a better clinical efficacy rather than the conventional upper arm double tourniquet (DT)
in distal upper extremity surgeries.
Methods: In this randomized controlled trial, 80 patients undergoing upper limb orthopedic surgeries were randomized
into two groups. IVRA was administered using lidocaine in both groups. Tourniquet pain was recorded based on visual
analogue scale (VAS). In case of pain (VAS>3) in the DT group, the proximal tourniquet was replaced with a distal
tourniquet while fentanyl 50μg was injected in the ST group. The onset time of tourniquet pain, time to reach to maximum
tourniquet pain and the amount of fentanyl consumption were compared between the two groups.
Results: No significant difference was seen in demographic characteristics. The onset time of tourniquet pain (VAS=1)
in the ST group (26.9±13.2 min) was longer than that of the DT group (13.8±4.8 min) (P<0.0001). The median of time to
reach to maximum tourniquet pain (VAS>3) in DT and ST groups were 25 and 40 minutes, respectively; indicating that
the patients in ST group reached to pain level at a significantly later time (P<0.0001). The total opioid consumption in
the DT group (61μg) was significantly lower than the ST group (102μg) (P<0.0001); however, both groups were similar
regarding fentanyl consumption before 40 minutes of surgeries.
Conclusion: It seems that in upper limb orthopedic surgeries with less than 40-minute duration, a single tourniquet
may serve as a proper alternative opposed to the conventional double tourniquet technique.


Main Subjects

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