Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2024; 15(2): 163-169
Published online Feb 18, 2024. doi: 10.5312/wjo.v15.i2.163
Effect of ankle versus thigh tourniquets on post-operative pain in foot and ankle surgery
Ashish Mishra, Ahmed Barakat, Jitendra Mangwani, Jakub Kazda, Sagar Tiwatane, Sana Mohammed Aamir Shaikh, Linzy Houchen-Wolloff, Vipul Kaushik
Ashish Mishra, Department of Trauma and Orthopedics, University Hospitals Leicester, Leicester LE1 5WW, United Kingdom
Ahmed Barakat, Department of Trauma and Orthopedics, Leicester University Hospitals-NHS Trust, Leicester LE1 5WW, Leicestershire, United Kingdom
Jitendra Mangwani, Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, United Kingdom
Jakub Kazda, Department of Anaesthesia, York & Scarborough Teaching Hospitals NHS Foundation Trust, North Yorkshire YO31 8HE, United Kingdom
Sagar Tiwatane, Department of Anaesthesia, Royal Free London NHS Trust, London NW3 2QG, United Kingdom
Sana Mohammed Aamir Shaikh, Department of Trauma & Orthopaedics, Breach Candy Hospital Trust, Mumbai 400026, India
Linzy Houchen-Wolloff, Department of Physiotherapy, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, United Kingdom
Vipul Kaushik, Department of Anasthesia, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, United Kingdom
Co-first authors: Ahmed Barakat and Ashish Mishra.
Author contributions: Mangwani J envisaged the research question and designed the study. Barakat A, Mishra A, Kazda J, Tiwatane S, Shaikh SMA, Kaushik V, and Houchen-Wolloff L collected the results. Both Barakat A and Mishra A were equally involved in results collections, results analysis, drafting and proof-reading the manuscript; All authors read and approved the manuscript prior to submission; Both Barakat A and Mishra A were equally involved in results collections, results analysis, drafting and proof-reading the manuscript.
Institutional review board statement: This study was reviewed and approved by the Leicester University Hospitals - NHS Trust as a service evaluation project.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Data sharing statement: Source data is available upon request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ahmed Barakat, MBChB, MSc, Surgeon, Department of Trauma and Orthopedics, Leicester University Hospitals-NHS Trust, University Hospitals of Leicester Headquarters, Level 3, Balmoral Building, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, Leicestershire, United Kingdom. ahmedharoonbarakat@gmail.com
Received: October 19, 2023
Peer-review started: October 19, 2023
First decision: November 23, 2023
Revised: December 19, 2023
Accepted: January 16, 2024
Article in press: January 16, 2024
Published online: February 18, 2024
Abstract
BACKGROUND

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.

AIM

To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery.

METHODS

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.

RESULTS

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 (r = 0.14, P = 0.04) but not at six or 24 h post-operatively.

CONCLUSION

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.

Keywords: Lower limb surgery, Tourniquet time, Tourniquet pressure, Tourniquet site, Post-operative pain, Pain scores

Core Tip: Tourniquets are standard in orthopedic extremity surgery, aiding blood loss control and surgical efficiency. However, varying guidelines and a lack of consensus on tourniquet parameters exist. This study prospectively examines tourniquet site and duration effects on post-operative pain scores using data from 201 patients undergoing foot and ankle surgery.