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
ARTICLE HIGHLIGHTS
Research background

Tourniquet utilization in orthopedic surgery is widespread for its benefits in blood loss reduction and enhanced surgical visibility, yet guidelines lack consensus on optimal pressure, placement, and duration. Despite its common use, there is limited understanding of how tourniquet site relates to postoperative pain in foot and ankle surgeries, highlighting a significant gap in existing knowledge.

Research motivation

The motivation behind this study stems from the existing ambiguity in guidelines regarding tourniquet practices in foot and ankle surgeries and the dearth of data on the connection between tourniquet site and postoperative pain. Understanding this relationship could not only improve patient outcomes but also guide surgical practices by providing evidence-based recommendations.

Research objectives

The primary objective of this study was to investigate the potential correlation between the tourniquet site and the intensity and duration of postoperative pain in patients undergoing foot and ankle surgery.

Research methods

The study analyzed prospectively collected data from 201 patients who underwent foot and ankle surgery in a single institution. Key variables included intra-operative tourniquet duration, pressure, site, and postoperative pain scores assessed through Visual Analogue Score at immediate recovery, six hours, and 24 h post-operation. Data analysis involved scatter plots and statistical testing using Pearson correlation.

Research results

There was no correlation between tourniquet pressure, site, and postoperative pain in foot and ankle surgery patients. All patients had standardized tourniquet pressures, and the weak correlation found between tourniquet time and immediate postoperative pain did not persist at six or 24 h post-operatively.

Research conclusions

The study demonstrates that tourniquet pressure and site do not significantly influence postoperative pain in foot and ankle surgery.

Research perspectives

The absence of a correlation suggests that the surgeon's preference in choosing a tourniquet is not necessarily tied to minimizing postoperative pain.