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Effects of acetylcysteine and ischaemic preconditioning on muscular function and postoperative pain after orthopaedic surgery using a pneumatic tourniquet

Published online by Cambridge University Press:  19 June 2006

J.-C. Orban ,
J. Levraut ,
S. Gindre ,
D. Deroche ,
B. Schlatterer ,
C. Ichai  and
D. Grimaud
J.-C. Orban
Affiliation:
Hôpital Saint-Roch, Département d'Anesthésie-Réanimation Est, Nice, France
J. Levraut
Affiliation:
Hôpital Saint-Roch, Département d'Anesthésie-Réanimation Est, Nice, France
S. Gindre
Affiliation:
Hôpital Saint-Roch, Département d'Anesthésie-Réanimation Est, Nice, France
D. Deroche
Affiliation:
Hôpital Saint-Roch, Département d'Anesthésie-Réanimation Est, Nice, France
B. Schlatterer
Affiliation:
Hôpital Saint-Roch, Service d'Orthopédie et Traumatologie, Nice, France
C. Ichai
Affiliation:
Hôpital Saint-Roch, Département d'Anesthésie-Réanimation Est, Nice, France
D. Grimaud
Affiliation:
Hôpital Saint-Roch, Département d'Anesthésie-Réanimation Est, Nice, France
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Abstract

Summary

Background and objective: The use of a pneumatic tourniquet can induce muscular and neurological complications in the operated limb. The genesis of these injuries could involve an ischaemia/reperfusion phenomenon and a compression under the cuff. We evaluated effects of an antioxidant, acetylcysteine and ischaemic preconditioning on the rhabdomyolysis and postoperative pain following a knee ligamentoplasty using a pneumatic tourniquet. Methods: We included 31 patients scheduled for a knee ligamentoplasty randomly assigned in three groups (control, acetylcysteine 1200 mg the day before and 600 mg at the operative day, ischaemic preconditioning). Results: There was a moderate rise in myoglobin and creatinine phosphokinase with no significant difference between the three groups. The muscular functional parameters were similar in all the groups. However, the morphine consumption within the first 48 h was smaller in the treatment groups (0.22 ± 0.31 mg kg−1 and 0.22 ± 0.23 mg kg−1 in the preconditioning and antioxidant groups, respectively) than in the control group (0.47 ± 0.33 mg kg−1, P <0.05). Conclusions: Acetylcysteine and ischaemic preconditioning do not decrease the extent of rhabdomyolysis related to the use of a pneumatic tourniquet and do not improve the postoperative muscle recovery. On the other hand, they allow a significant reduction in the postoperative morphine consumption.

Keywords

TOURNIQUETACETYLCYSTEINEREPERFUSION INJURYORTHOPAEDICSPAIN, postoperative
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 12 , December 2006 , pp. 1025 - 1030
Copyright
2006 European Society of Anaesthesiology

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