Mishra Ashish, Barakat Ahmed, Mangwani Jitendra, Kazda Jakub, Tiwatane Sagar, Shaikh Sana Mohammed Aamir, Houchen-Wolloff Linzy, Kaushik Vipul
Department of Trauma and Orthopedics, University Hospitals Leicester, Leicester LE1 5WW, United Kingdom.
Department of Trauma and Orthopedics, Leicester University Hospitals-NHS Trust, Leicester LE1 5WW, Leicestershire, United Kingdom.
World J Orthop. 2024 Feb 18;15(2):163-169. doi: 10.5312/wjo.v15.i2.163.
Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss, improve visualization in the surgical field, and to potentially reduce surgical time. There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure, placement site, and duration of use. There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery.
To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery.
Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken. Intraoperative tourniquet duration, tourniquet pressure and site, and postoperative pain scores using Visual Analogue Score were collected in immediate recovery, at six hours and at 24 h post-op. Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure, duration, site, and pain scores using Pearson correlation coefficient.
All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh. There was no correlation between the site of the tourniquet and pain scores in recovery, at six hours and after 24 h. There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op ( = 0.14, = 0.04) but not at six or 24 h post-operatively.
This study shows that there was no statistically significant correlation between tourniquet pressure, site and post-op pain in patients undergoing foot and ankle surgery. The choice of using a tourniquet is based on the surgeon's preference, with the goal of minimizing the duration of its application at the operative site.
止血带常用于择期肢体骨科手术，以减少失血、改善手术视野并可能缩短手术时间。现有指南对于最佳止血带压力、放置部位和使用时长缺乏共识。关于止血带部位与足踝手术术后疼痛之间的关系，数据较少。
探讨择期足踝手术患者止血带部位与术后疼痛评分强度之间的关系。
对前瞻性收集的某单一机构201例行足踝手术患者的数据进行回顾性分析。收集术中止血带使用时长、止血带压力和部位，以及术后即刻、术后6小时和24小时使用视觉模拟评分法的术后疼痛评分。使用散点图分析数据，并使用Pearson相关系数评估止血带压力、时长、部位与疼痛评分之间的统计相关性。
所有接受足踝手术的患者，踝关节止血带压力为250 mmHg，大腿止血带压力为300 mmHg。止血带部位与术后即刻、6小时和24小时的疼痛评分之间无相关性。止血带使用时间与术后即刻视觉模拟评分之间存在弱相关性（r = 0.14，P = 0.04），但术后6小时和24小时无相关性。
本研究表明，接受足踝手术的患者，止血带压力、部位与术后疼痛之间无统计学显著相关性。止血带的使用选择基于外科医生的偏好，目标是尽量缩短其在手术部位的应用时长。
