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

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 (61 µg) was significantly lower than the ST group (102 µg) ( 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. Level of evidence: II.