Purpose of Review

Approximately 20% of patients undergoing surgery develop persistent lower extremity pain following total knee arthroplasty. Animal studies have confirmed that prolonged tourniquet time increases the risk of endoneural ischemia and can mediate or modulate the development of chronic pain. The use of Near InfraRed Spectroscopy (NIRS) adjacent to nerve tissue, previously described as ONG has been shown to detect early neural compromise and has demonstrated clinical utility in carpal tunnel diagnosis.

Recent Findings

In this pilot study, we recruited 10 healthy adult volunteers to undergo oxyneurography (ONG) and sensory nerve conduction testing (sNCT). We performed testing on the upper and lower extremities in each individual. The tourniquet was applied followed by measurements of sNCT and ONG as described. We observed a significant drop in the mean ONG index at 3 and 5 min following tourniquet inflation in upper and lower extremities. Similar to raw ONG values, there was significant variability in sNCT measurements, which in general increased from baseline with tourniquet inflation. In the upper extremity, there was a significant increase in sNCT with tourniquet inflation, while in the lower extremity, there was a trend towards significance.

Summary

The use of ONG can be supported as a diagnostic tool to detect nerve ischemia and to potentially reduce the incidence of tourniquet-mediated or -modulated neural ischemia and reduce the development of chronic post-tourniquet pain.

中文翻译：

---

止血带在疼痛状态发展中的作用：新型临床试验研究和组织血氧饱和度法测量神经缺血的回顾。

审查目的

全膝关节置换术后约有20％的患者会出现持续的下肢疼痛。动物研究已经证实，止血带时间延长会增加神经内膜缺血的风险，并且可以介导或调节慢性疼痛的发展。已显示，与神经组织相邻的近红外光谱法（NIRS）（以前称为ONG）的使用可检测早期的神经损害，并已证明在腕管诊断中具有临床实用性。

最近的发现

在这项先导研究中，我们招募了10位健康的成年人志愿者进行氧合神经造影（ONG）和感觉神经传导测试（sNCT）。我们对每个人的上肢和下肢进行了测试。施加止血带，然后按上述方法测量sNCT和ONG。我们观察到上肢和下肢止血带充气后3分钟和5分钟的平均ONG指数显着下降。类似于原始ONG值，sNCT测量值存在显着差异，通常随着止血带膨胀而从基线开始增加。在上肢中，随着止血带膨胀，sNCT显着增加，而在下肢中，sNCT呈显着趋势。

概要

ONG的使用可以作为一种诊断工具来检测神经缺血，并有可能减少止血带介导或调节的神经缺血的发生率，并减轻慢性止血带后疼痛的发生。