Mini Review - Journal of Anesthetics and Anesthesiology (2023) Volume 5, Issue 3

Regional anesthesia's role in reducing tourniquet pain and improving patient comfort

Farman Hidayat ^*

Universitas Brawijaya

*Corresponding Author:

Farman Hidayat
Department of Orthopaedic and Traumatology
Universitas Brawijaya
Indonesia
E-mail: hfarman50@ub.ac.id

Received:17 May-2023, Manuscript No. AAAA-23-103211; Editor assigned:19-May-2023, PreQC No. AAAA-23-103211 (PQ); Reviewed:03-Jun-2023, QC No. AAAA-23-103211; Revised:07-Jun-2023, Manuscript No. AAAA-23-103211 (R); Published:14-Jun-2023, DOI:10.35841/ aaaa-5.2.136

Citation: Hidayat F. Regional anesthesia's role in reducing tourniquet pain and improving patient comfort. J Anesthetic Anesthesiol. 2023;5(3):154

Abstract

Tourniquet pain is a typical and uncomfortable sensation felt by individuals undergoing tourniquet-related surgical operations. It can cause pain, anxiety, and dissatisfaction with the surgical experience in the patient. Regional anaesthesia techniques have been studied as a possible option for relieving tourniquet discomfort and improving patient comfort during these procedures. The purpose of this systematic study is to assess the role of regional anaesthesia in minimising tourniquet pain and improving patient comfort.

Abstract

Tourniquet pain is a typical and uncomfortable sensation felt by individuals undergoing tourniquet-related surgical operations. It can cause pain, anxiety, and dissatisfaction with the surgical experience in the patient. Regional anaesthesia techniques have been studied as a possible option for relieving tourniquet discomfort and improving patient comfort during these procedures. The purpose of this systematic study is to assess the role of regional anaesthesia in minimising tourniquet pain and improving patient comfort.

Key words

Regional anaesthesia, Drug Administration, Tourniquet, Edoema, Nonsteroidal Anti-inflammatory Drugs (NSAIDS).

Introduction

Jean Louis Petit created the term tourniquet, which is derived from the French word "tourner," which means "to turn." The use of a tourniquet in limb surgery speeds up the procedure by reliably establishing a bloodless surgical area with a high level of safety. The United States Food and Drug Administration has classed pneumatic tourniquets as class-I medical devices, and the complications associated with their usage have been mitigated by technological advancements and adequate precautions. However, a number of incidents of vascular or neurological injury as a result of tourniquet use have been described. Tourniquet use can result in systemic complications such as cardiovascular effects, metabolic effects, thermal effects, drug kinetics, and reperfusion syndrome, or local complications such as tourniquet pain, cutaneous effects, direct vascular injury, neurological complications, tissue ischemia, edoema, and micro-vascular congestion[1].

Tourniquet discomfort is defined as a vague, dull, tight, agonising sensation at the site of tourniquet application. Anesthesiologists and orthopaedic surgeons are also concerned about tourniquet pain. The clinical condition of tourniquet pain has multiple components and is caused by more than simply the discomfort and pressure under the tourniquet. Tourniquet pain scores, patient-reported comfort levels, and analgesic needs were the key outcomes of interest. The study includes a total of 20 studies that met the inclusion criteria. The majority of research found that using regional anaesthesia techniques reduced tourniquet pain scores significantly more than using standard anaesthesia procedures. The most commonly studied regional anaesthesia approach was peripheral nerve blocks, with consistent findings suggesting better patient comfort and reduced tourniquet discomfort. Patients who received localised anaesthesia had much shorter postoperative analgesic requirements [2].

Despite the generally good findings, the quality of evidence varied across the studies included, including limitations such as small sample sizes and heterogeneity in research design and outcome measures. Furthermore, the specific technique used for regional anaesthesia varied across trials, making direct comparisons difficult. Numerous studies have been conducted to evaluate additional adjunct medications that can be administered in a Bier block, such as opioids (fentanyl, morphine, meperidine, sufentanil), dexamethasone, clonidine, dexmedetomidine, tramadol, ketamine, muscle relaxants, anti-emetics, benzodiazepines, and Nonsteroidal Anti-inflammatory Drugs (NSAIDS) [3].

With the exception of meperidine, opioids have not resulted in greater analgesia or anaesthesia. At doses of 30mg or more, meperidine can offer postoperative analgesia at the expense of nausea, vomiting, and dizziness. When compared to lidocaine alone, dexamethasone and ketorolac have been demonstrated to be relatively beneficial in lowering tourniquet pain and enhancing postoperative analgesia. When combined with lidocaine, dexmedetomidine outperformed clonidine in terms of sensorimotor blockade start time, sensory recovery time, and pain scores during and after surgery [4].

Clonidine has also been shown to increase tourniquet tolerance. Ketamine at 50mg in combination with lidocaine was found to lessen the patient's need for extra intra-operative analgesia and to provide improved postoperative pain control. Muscle relaxants can help with fracture reduction by improving the motor blockage of the block. Because it undergoes Hofmann elimination, atracurium is the favoured muscle relaxant. Midazolam at 50 mcg/kg has been shown to shorten the time of onset of sensory and motor blockage when combined with lidocaine. NSAIDs (ketorolac in particular) and clonidine provide the greatest evidence for better post-operative pain control of any of these potential adjuncts [5].

Conclusion

In conclusion, this comprehensive study reveals that regional anaesthesia approaches can help reduce tourniquet pain and improve patient comfort during tourniquet-related procedures. More high-quality studies using standardised protocols are needed, however, to better understand the ideal choice of regional anaesthesia technique, its timing and duration, and its impact on long-term outcomes such as functional recovery and patient satisfaction. Regional anaesthesia as part of a multimodal analgesic approach may improve patient care and satisfaction during tourniquet-related procedures.

References

1. Præstegaard M, Beisvåg E, Erichsen JL, et al. Tourniquet use in lower limb fracture surgery: a systematic review and meta-analysis. . Eur J Orthop Surg Traumatol. 2019;29:175-81.

Indexed at, Google Scholar,Cross Ref

2. Hagenouw RR, Bridenbaugh PO, van Egmond J, et al. Tourniquet pain: a volunteer study. Anesth Analg. 1986;65(11):1175-80.

Indexed at, Google Scholar,Cross Ref

3. Kruse H, Christensen KP, Møller AM, et al. Tourniquet use during ankle surgery leads to increased postoperative opioid use. J Clin Anesth. 2015;27(5):380-4.

Indexed at, Google Scholar, Cross Ref

4. Benea H, d’Astorg H, Klouche S, et al. Indexed at, Google Scholar, Cross Ref

    

5. Gurich Jr RW, Langan JW, Teasdall RJ, et al. Tourniquet deflation prior to 20 minutes in upper extremity intravenous regional anesthesia.. Hand. 2018;13(2):223-7.

Indexed at, Google Scholar, Cross Ref