The Effect of Upper Extremity Tourniquet Time on Postoperative Pain and Opiate Consumption

Improving the Safety of Tourniquet Use in a Trauma Theatre According to the British Orthopaedic Association Guidelines: A Closed Loop Audit

Introduction Tourniquets are used widely in trauma and orthopaedic surgery to reduce blood loss and facilitate better visualisation of the operative field; however, some complications can result from improper use such as pressure sores, chemical burns, compartment syndrome, and deep vein thrombosis. We audited the use of intraoperative tourniquets in our trauma theatre against the guidance published by the British Orthopaedic Association (BOA) in 2021. Methods This was a closed-loop audit evaluating 80 trauma operations that utilised tourniquets. In the first cycle, we audited 40 operations (23 upper limbs vs 17 lower limbs) over a period of two months through a review of operation notes and theatre documentation. We presented our findings and implemented changes including the addition of tourniquet use to the operation note template and labels on the tourniquet machines aiding the calculation of tourniquet pressures. A re-audit was then performed involving a further 40 operations (20 upper limbs and 20 lower limbs). Statistical analyses were performed to compare the two cycles. Results Tourniquet time was on average similar across both audit cycles (60.7 vs 70.0, p = 0.192) with compliance up to standard in 97% of cases. Post-intervention, there was an improvement in the documentation of skin status (37 vs 69%, p = 0.004), tourniquet isolation method (43% vs 74%, p = 0.003), and tourniquet pressure (71% vs 94%, p = 0.003). The difference between tourniquet pressure and systolic blood pressure was on average lower post-intervention for the upper limb (125.9 vs 99.9, p < 0.01) and lower limb operations (154.2 vs 121.7, p < 0.01). Adherence to the British Orthopaedic Association Standards for Trauma (BOAST) guidance with tourniquet pressure improved with intervention (25% vs 75%). Conclusion The introduction of tourniquet parameters in the operation note template and patient-specific calculation of tourniquet pressures improved the safe use of tourniquets within the trauma theatre.

Perioperative Pain Management for Distal Radius Fractures

Distal radius fractures have a high incidence among both young and elderly patients, and in many instances require operative intervention. When operative intervention is employed, adequate pain management is essential to decrease postoperative complications, such as chronic pain and disability, while minimizing the risk of prolonged opioid use and dependence. Strategies to optimize pain management include regional anesthesia, preoperative dosing of medication, multimodal regimens, long-acting selective opioids at the time of surgery, corticosteroids, and non-pharmacologic therapies.