Background: Pneumatic arterial tourniquet is a very commonly used technique\nin limb surgeries to provide bloodless field to facilitate dissection and\ndecrease blood loss. However, arterial tourniquet has many deleterious effects\nincluding hemodynamic changes, serum lactate and potassium level changes\nand tourniquet-induced pain which sometimes can be severe and intolerable.\nAim of the study: To evaluate the effect of different regional blocks: femoralsciatic,\nspinal and epidural blocks on serum lactate and potassium levels and\nthe degree of arterial tourniquet-induced pain in patients undergoing lower\nlimb orthopedic surgeries. Methods: 60 patients underwent lower limb orthopedic\nsurgery with application of tourniquet for duration not more than 90\nminutes. Patients were assigned randomly to one of three groups (20 each)\nGroup I had sciatic-femoral block, Group II: patients had spinal anesthesia\nand Group III: patients had epidural anesthesia. Intraoperative hemodynamics,\nchanges in serum potassium and lactate levels and tourniquet pain after\ntourniquet inflation & deflation, were recorded. Results: There was no statistically\nsignificant difference among the three groups regarding tourniquet\npain after tourniquet inflation (p = 0.872) and deflation (p = 0.902), and regarding\nserum levels changes of potassium (p = 0.067) and lactate (p =\n0.051). However, each group showed statistically significant increase in post\ndeflation tourniquet pain (p = 0.003, 0.002, 0.003, in groups F, S, E respectively)\nand serum potassium (p = 0.004, 0.006, 0.000, in groups F, S, E respectively)\nand lactate levels (p = 0.004, 0.000, 0.000, in groups F, S, E respectively)\nwhen compared to the pre-deflation values, and the increase was directly proportional to the duration of tourniquet. Conclusion: the three\ndifferent types of anesthesia (femoral- sciatic, spinal and epidural block) have\nthe same effect on serum lactate and potassium levels and the degree of tourniquet\npain, which were related to the duration of tourniquet inflation.
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