Case study: Tourniquet pain

The most common complication of a tourniquet during orthopedic surgery is tourniquet pain, which, in turn, is why peripheral nerve blocks for distal surgery can not be used as a single anesthesia modality. Read on to find out how we approach tourniquet pain in our headquarters.

A tourniquet can be applied below the knee for foot surgery, but some surgeons are uncomfortable with this. For foot surgery, we often use long-acting local anesthetics (e.g., ropivacaine, bupivacaine) for ankle or popliteal blocks, and shorter-acting local anesthetics (e.g., lidocaine) for femoral nerve block for tourniquet pain. This allows the analgesic block for tourniquet pain to resolve quickly after surgery, leaving the long-acting popliteal or ankle block for postoperative analgesia. With this strategy and intraoperative sedation, most patients tolerate tourniquet pain for up to 45 minutes.

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