Is Tourniquet pain the result of increased compartment pressure in the forearm?
Carl H. Manstein*1, Samuel M. Manstein2
1Temple University, Elkins Park, PA; 2Department of Surgery, Dartmouth Medical Center, Hanover, NH
THe pneumatic tourniquet has been a mainstay in upper extremity surgery by allowing the surgeon to operate in a blood-free field. Many upper extremity surgical procedures are done under local anesthesia or minimal sedation. The problem of tourniquet pain is a vexing one. The question is posed "Is tourniquet pain the result of increased compartment pressure in the forearm?"
This study measure the compartment pressures of the volar forearm in 10 healthy normotensive volunteers before inflation of a pneumatic tourniquet. An Esmarch elastic band was used as an initial step and the tourniquet was set to 100 mm Hg above the subject's systolic blood pressure. Compartment pressures were measure using a Stryker needle manometer. These initial pressure measurements were then compared to forearm measurements taken while the tourniquet was still inflated at 15 minutes post-inflation.
There was no increase in the volar flexor compartment pressure of the forearm after 15 minutes of tournquet inflation. All subjects compained of pain of the forearm, characteristic of what is commonly called "tourniquet pain".
We therefore conclude that in the upper extremtiy, at least of relatively short operating times, appropriate inflation of a tourniquet does not induce the early onset of increased compartment pressure in the forearm. We further conclude that tourniquet is not the result of increased compartment pressure in the forearm.
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