Trousseau’s sign in orthopedic: a rare sequelae of inadequate postoperative pain management

Authors

  • Hriday P. Acharya Department of Orthopaedics, B J Medical College and Civil Hospital, Asarwa, Ahmedabad, Gujarat, India
  • Zulfikar M. Patel Department of Orthopaedics, B J Medical College and Civil Hospital, Asarwa, Ahmedabad, Gujarat, India
  • Nirav K. Mungalpara Department of Orthopaedics, B J Medical College and Civil Hospital, Asarwa, Ahmedabad, Gujarat, India
  • Meet S. Mehta Department of Orthopaedics, B J Medical College and Civil Hospital, Asarwa, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20185336

Keywords:

Pain management, Fractures, Trousseau's sign, Calcium metabolism, Respiratory alkalosis

Abstract

Background: Pain management in orthopedic is very crucial matter to handle, which is many a times not managed properly and that leads to various medical complications to the patients. Trousseau sign of latent tetany is a medical sign observed in patients with low calcium. This is the first and one of a kind case series describing the development and pathogenesis of Trousseau sign in orthopedics.

Methods: This is a case series of 5 patients with lower limb fractures who underwent surgery. All these patients developed Trousseau's sign in immediate postoperative period. All the patients were investigated and were diagnosed with respiratory alkalosis. They were managed with closed bag ventilation which relieved the symptoms.

Results: Here we put forward a direct physiological and psychological relation between a low pain threshold and associated hyperventilation with lead to development of Trousseau's sign in our patients. So, next time in postoperative round, if we see patient hyperventilating and complaining about fixed hand’s position, do not start calcium gluconate drip immediately, it may be due to respiratory alkalosis, then closed bag ventilation would be suffice.

Conclusions: Trousseau’s sign seen postoperatively in Orthopedics may be commonly due to inadequate pain management rather than altered calcium metabolism.

 

References

Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. J Am Soc Anes. 2009;111(3):657-77.

Gan TJ. Postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287–98.

Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG. Preoperative prediction of severe postoperative pain. Journal of the International Association for the Study of Pain. 2003;105(3):415-23.

Munafò MR, Stevenson J. Anxiety and surgical recovery, Reinterpreting the literature. J Psychosomatic Res. 2001;51(4):589-96.

Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. British Journal Anaesthesia. 2002;89(3):409-23.

Hehrmann R. Hypocalcemic crisis. Hypoparathyroidism-- non-parathyroid origin--the most frequent form: hyperventilation syndrome. Fortschritte der Medizin. 1996;114(17):223-6.

Sauty A, Prosper M. The hyperventilation syndrome. Revue médicale Suisse. 2008;4(180):2500-5.

Garssen B, Buikhuisen M, van Dyck R. Hyperventilation and panic attacks. Am J Psych. 1996;153(4):513-8.

Rehman HU, Wunder S. Trousseau sign in hypocalcemia. Can Med Assoc J. 2011;183(8):E498.

Moon HS, Lee SK, Chung JH, In CB. Hypocalcemia and hypokalemia due to hyperventilation syndrome in spinal anesthesia -A case report. Korean J Anesthesiol. 2011;61(6):519–23.

Macefield G, Burke D. Paraesthesia and tetany induced by voluntary hyperventilation, Increased excitability of human cutaneous and motor axons. Brain. 1991;114 ( Pt 1B):527-40.

Folgering H. The pathophysiology of hyperventilation syndrome. Monaldi Arch Chest Dis. 1999;54(4):365-72.

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Published

2018-12-25

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Original Research Articles