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Effects of Tourniquets in the Development of Pain States: a Novel Clinical Pilot Study and Review of Utilization of Tissue Oximetry to Measure Neural Ischemia

  • Other Pain (AD Kaye and N Vadivelu, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Approximately 20% of patients undergoing surgery develop persistent lower extremity pain following total knee arthroplasty. Animal studies have confirmed that prolonged tourniquet time increases the risk of endoneural ischemia and can mediate or modulate the development of chronic pain. The use of Near InfraRed Spectroscopy (NIRS) adjacent to nerve tissue, previously described as ONG has been shown to detect early neural compromise and has demonstrated clinical utility in carpal tunnel diagnosis.

Recent Findings

In this pilot study, we recruited 10 healthy adult volunteers to undergo oxyneurography (ONG) and sensory nerve conduction testing (sNCT). We performed testing on the upper and lower extremities in each individual. The tourniquet was applied followed by measurements of sNCT and ONG as described. We observed a significant drop in the mean ONG index at 3 and 5 min following tourniquet inflation in upper and lower extremities. Similar to raw ONG values, there was significant variability in sNCT measurements, which in general increased from baseline with tourniquet inflation. In the upper extremity, there was a significant increase in sNCT with tourniquet inflation, while in the lower extremity, there was a trend towards significance.

Summary

The use of ONG can be supported as a diagnostic tool to detect nerve ischemia and to potentially reduce the incidence of tourniquet-mediated or -modulated neural ischemia and reduce the development of chronic post-tourniquet pain.

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Authors and Affiliations

  1. Department of Anesthesiology, Duke University School of Medicine and Durham Veterans Affairs Health Systems, 508 Fulton St, Durham, NC, 27705, USA

    Srinivas Pyati, Julien Cobert & Karthik Raghunathan

  2. Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA

    Joe F. Jabre

  3. Department of Anesthesiology, Louisiana State University Health Sciences Center, 1542 Tulane Ave, Suite 656, New Orleans, LA, 70112, USA

    Alan D. Kaye & James H. Diaz

Authors
  1. Srinivas Pyati
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  2. Julien Cobert
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  3. Joe F. Jabre
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  4. Alan D. Kaye
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  5. James H. Diaz
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  6. Karthik Raghunathan
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Corresponding author

Correspondence to Karthik Raghunathan.

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Conflict of Interest

Srinivas Pyati, Julien Cobert, Joe F Jabre, James H. Diaz, and Karthik Raghunathan declare no conflict of interest.

Our manuscript discusses unlabeled/investigational use of Cerebral Oximeter (ORE-SIGHT® (Casmed, Branford, CT) device for the use of measuring nerve oxygenation solely for this study.

Alan Kaye is a Section Editor for Current Headache and Pain Reports. He has not been involved in the editorial handling of this manuscript. Dr. Kaye is also a speaker for Merck.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Pyati, S., Cobert, J., Jabre, J.F. et al. Effects of Tourniquets in the Development of Pain States: a Novel Clinical Pilot Study and Review of Utilization of Tissue Oximetry to Measure Neural Ischemia. Curr Pain Headache Rep 24, 25 (2020). https://doi.org/10.1007/s11916-020-00855-x

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  • DOI: https://doi.org/10.1007/s11916-020-00855-x

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