Zhao Guoshun, L Guowei, Shao Fugen (Acupuncture Anesthesia Group, Department of Anaesthesia and Laboratory of Acupuncture Anaesthesia and Encephalology, Beijing Chishuitan Hospital)
The application of a tourniquet to a limb has been the measure to provide a bloodless field for limb operations under drug anaesthesia for a century. However, it has been shown in recent years in limb operations under acupuncture anaesthesia that the conventional use of a single tourniquet frequently interfered with the improvement of the effect of acupuncture anaesthesia. With reference to our past investigations, it is thought that this is probably related to the dysfunction of larger nerve fibers effected by the tourniquet and thereby resulting in discharge of smaller nerve fibers and the tourniquet reaction. Considering that this phenomenon is mainly due to the compression from the tuorniquet and the impairment made to the larger fibers underneath, alternate application of two tourniquets was tried to shift the site of compression. It was shown that, by so doing, the formerly dysfunctioned larger fibers recovered and activities of the discharged smaller fibers and the tourniquet reaction were reinhibited, with the improvement of the effect of acupuncture anaesthesia.
The practice was to apply another tourniquet below the conventional site of the single tourniquet to be inflated alternately to block up the circulation of the limb. 120 patients undergoing limb operation under acupuncture anaesthesia were observed. The single-tourniquet group and double-tourniquet group were observed respectively for their time tolerance to the tourniquet and the effect of acupuncture anaesthesia. And, there were 21 normal volunteers, male and female, for the experiment. The data obtained during the course of application of double-tourniquet were as follows: (1) time tolerance to the tourniquet, (2) complaint and reaction, (3) cutaneous sensations of the tested limb, two-point discrimination, light tactility, pricking and sense of cold, (4) sense of pain and sense of warmth.
Results of the clinical observation and experiment showed: (1) By means of the alternate application of double-tourniquet, time tolerance to the tourniquet could be markedly prolonged and percentage of excellent and good results of acupuncture anaesthesia was significantly increased by 22.5% and 21.7% with the upper and lower limbs respectively. (2) "Tourniquet Reactions" -- severe pain of the limb, nausea, palpitation and the elevation in blood pressure and pulse rate -- appeared within a certain time after the application of the first tourniquet, but were relieved rapidly after the inflation of the second tourniquet and deflation of the first one. (3) During the course of application of the tourniquets, hypoesthesia or anaesthesia of two-point discrimination and light tactility (conducted by larger fibers) was prior to diminution or loss of pricking pain and sense of cold (conducted by smaller fibers).
The results suggest that due to the shifting of the site of tourniquet compression, the formerly dysfunctions of larger fibers were relieved and thereby the tourniquet niquet reactions delayed, the time tolerance to tourniquet prolonged and the effect of acupuncture anaesthesia improved.
The application of a tourniquet to a limb has been the measure to provide a bloodless field for limb operations under drug anaesthesia for a century. However, it has been shown in recent years in limb operations under acupuncture anaesthesia that the conventional use of a single tourniquet frequently interfered with the improvement of the effect of acupuncture anaesthesia. With reference to our past investigations, it is thought that this is probably related to the dysfunction of larger nerve fibers effected by the tourniquet and thereby resulting in discharge of smaller nerve fibers and the tourniquet reaction. Considering that this phenomenon is mainly due to the compression from the tuorniquet and the impairment made to the larger fibers underneath, alternate application of two tourniquets was tried to shift the site of compression. It was shown that, by so doing, the formerly dysfunctioned larger fibers recovered and activities of the discharged smaller fibers and the tourniquet reaction were reinhibited, with the improvement of the effect of acupuncture anaesthesia.
The practice was to apply another tourniquet below the conventional site of the single tourniquet to be inflated alternately to block up the circulation of the limb. 120 patients undergoing limb operation under acupuncture anaesthesia were observed. The single-tourniquet group and double-tourniquet group were observed respectively for their time tolerance to the tourniquet and the effect of acupuncture anaesthesia. And, there were 21 normal volunteers, male and female, for the experiment. The data obtained during the course of application of double-tourniquet were as follows: (1) time tolerance to the tourniquet, (2) complaint and reaction, (3) cutaneous sensations of the tested limb, two-point discrimination, light tactility, pricking and sense of cold, (4) sense of pain and sense of warmth.
Results of the clinical observation and experiment showed: (1) By means of the alternate application of double-tourniquet, time tolerance to the tourniquet could be markedly prolonged and percentage of excellent and good results of acupuncture anaesthesia was significantly increased by 22.5% and 21.7% with the upper and lower limbs respectively. (2) "Tourniquet Reactions" -- severe pain of the limb, nausea, palpitation and the elevation in blood pressure and pulse rate -- appeared within a certain time after the application of the first tourniquet, but were relieved rapidly after the inflation of the second tourniquet and deflation of the first one. (3) During the course of application of the tourniquets, hypoesthesia or anaesthesia of two-point discrimination and light tactility (conducted by larger fibers) was prior to diminution or loss of pricking pain and sense of cold (conducted by smaller fibers).
The results suggest that due to the shifting of the site of tourniquet compression, the formerly dysfunctions of larger fibers were relieved and thereby the tourniquet niquet reactions delayed, the time tolerance to tourniquet prolonged and the effect of acupuncture anaesthesia improved.
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