Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2015; 6(4): 394-399
Published online May 18, 2015. doi: 10.5312/wjo.v6.i4.394
Nerve compression and pain in human volunteers with narrow vs wide tourniquets
Florian M Kovar, Manuela Jaindl, Gerhard Oberleitner, Georg Endler, Julia Breitenseher, Daniela Prayer, Gregor Kasprian, Florian Kutscha-Lissberg
Florian M Kovar, Manuela Jaindl, Gerhard Oberleitner, Department of Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
Georg Endler, Labors.at, 1190 Vienna, Austria
Julia Breitenseher, Daniela Prayer, Gregor Kasprian, Department of Radiology, Medical University Vienna, 1090 Vienna, Austria
Florian Kutscha-Lissberg, Department of Orthopedics, Landesklinikum Wr. Neustadt, 2700 Wr. Neustadt, Austria
Author contributions: Kovar FM and Kasprian G contributed equally to this work; Jaindl M, Prayer D and Kutscha-Lissberg F designed the research; Kovar FM, Oberleitner G and Breitenseher J performed the research; Kovar FM and Endler G analyzed the data; Kovar FM and Jaindl M wrote the paper.
Supported by Different sources: Volunteers honorary in the amount of 3.000 USD was supported by private funds of Kovar FM; HemaClear™ devices were provided by OHK Medical Device, Haifa, Israel. There is no other conflict of interest for the involving authors.
Ethics approval: The study was reviewed and approved by the IRB, Medical University Vienna, EK-1042/2011.
Clinical trial registration: The study is registered under NCT02023476 at https://clinicaltrials.gov/ct2/show/NCT02023476?term=hemaclear&rank=1.
Informed consent: All study participants provided informed written consent prior to study enrillment.
Conflict-of-interest: The present paper was supported by different sources: Volunteers honorary in the amount of 3.000 USD was supported by private funds of Kovar FM; HemaClear™ devices were provided by OHK Medical Device, Haifa, Israel. An agreement with representatives auf Zimmer Inc. in Austria failed, for providing an A.T.S.® 3000 Automatic tourniquet system, as used by McEwen. We herby certify that there are no other actual or potential conflicts of interest for the authors of the present paper. There are no other undisclosed financial or personal relationships with other people or organizations that could inappropriately influence our work. All other authors do not have a conflict of interest.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Florian M Kovar, MD, Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. florian.kovar@meduniwien.ac.at
Telephone: +43-1-4040059020 Fax: +43-1-4040059490
Received: October 17, 2014
Peer-review started: October 20, 2014
First decision: January 8, 2015
Revised: January 14, 2015
Accepted: February 9, 2015
Article in press: February 12, 2015
Published online: May 18, 2015
Processing time: 215 Days and 14.5 Hours
Abstract

AIM: To assess the clinical effects and the morphological grade of nerve compression.

METHODS: In a prospective single-center randomized, open study we assessed the clinical effects and the morphological grade of nerve compression during 20 min of either a silicon ring (group A) or pneumatic tourniquet (group B) placement variantly on the upper non-dominant limb in 14 healthy human volunteers. Before and during compression, the median and radial nerves were visualized in both groups by 3 Tesla MR imaging, using high resolutional (2.5 mm slice thickness) axial T2-weighted sequences.

RESULTS: In group A, Visual analog pain scale was 5.4 ± 2.2 compared to results of group B, 2.9 ± 2.5, showing a significant difference (P = 0.028). FPS levels in group A were 2.6 ± 0.9 compared to levels in group B 1.6 ± 1, showing a significant difference (P = 0.039). Results related to measureable effect on median and radial nerve function were equal in both groups. No undue pressure signs on the skin, redness or nerve damage occurred in either group. There was no significant difference in the diameters of the nerves without and under compression in either group on T2 weighted images.

CONCLUSION: Based on our results, no differences between narrow and wide tourniquets were identified. Silicon ring tourniquets can be regarded as safe for short time application.

Keywords: Nerve compression; Magnetic resnane iamge; Wide tourniquet; Narrow tourniquet; Human volunteers

Core tip: Nerve injury is a serious potential complication associated with clinical use of tourniquets in surgery. In a prospective single-center randomized, open study we assessed the clinical effects and the morphological grade of nerve compression during 20 min of either a silicon ring (group A) or pneumatic tourniquet (group B) placement variantly on the upper non-dominant limb, visualized by 3 Tesla magnetic resonance imaging, using high resolutional (2.5 mm slice thickness) axial T2-weighted sequences. Based on our results, no differences between narrow and wide tourniquets were identified. Silicon ring tourniquets can be regarded as safe for short time application.