Comparative evaluation between ascorbic acid and N-acetyl cysteine for preventing tourniquet induced ischaemic reperfusion injury during lower limb surgery, a randomized controlled trial

Peer review under responsibility of Egyptian Society of Anesthesiologists.

Figures & data

igure 3 Participant‘s flow diagram.

able 1 Demographic and operative data.

Variable	Group A (N = 20)	Group N (N = 20)	Group C (N = 20)	p-value
Male/Female	11/9	10/10	11/9	0.935
Age (years)	36 (6)	35 (8)	35 (7)	0.875
BMI (kg/m^2)	23.8 (2.7)	24.2 (2.5)	23.9 (2.6)	0.880
Surgical procedure				0.360
Fixation of tibial fracture	8 (40%)	8 (40%)	9 (45%)
Fixation of ankle fracture	8 (40%)	9 (45%)	8 (40%)
Knee arthroscopic	4 (20%)	3 (15%)	3 (15%)
Local anesthetic volume (ml)	12.5 (1.4)	12.4 (1.5)	12.3 (1.3)	0.904
Level of sensory block T11 (T10–T12)	20 (100%)	20 (100%)	20 (100%)	0.958
Tourniquet time (min)	74 (13)	75 (14)	77 (11)	0.751

Data are presented as ratio, mean (SD), number (%), or median (interquartile range).

BMI, body mass index.

able 2 Assays of plasma malonyldialdehyde and serum interleukins levels.

Variable	Time	Group A (n = 20)	Group N (n = −20)	Group C (n = −20)	p-value
MDA (nmol/l)	T0	2.9 (0.7)	3.0 (0.8)	2.8 (0.9)	0.735
	T1	3.0 (0.6)	3.0 (0.7)	2.9 (0.8)	0.875
	T2	2.7 (0.9)	2.8 (0.8)	2.8 (0.8)	0.909
	T3	3.0 (0.7)	2.9 (0.8)	6.1 (0.4)^a	<0.0001
	T4	2.9 (0.7)	3.0 (0.8)	5.8 (0.8)^a	<0.0001
	T5	2.9 (0.7)	3.0 (0.8)	5.5 (0.8)^a	<0.0001
IL-6 (pg/ml)	T0	2.7 (0.8)	2.8 (0.7)	2.9 (0.7)	0.692
	T1	3.4 (0.7)	3.3 (0.6)	3.4 (0.6)	0.848
	T2	3.9 (0.60	4.1 (0.4)	4.0 (0.5)	0.464
	T3	6.8 (0.5)	6.7 (0.6)	12.3 (0.8)^a	<0.0001
	T4	6.4 (0.7)	6.5 (0.9)	13.2 (0.8)^a	<0.0001
	T5	5.3 (0.6)	5.4 (0.8)	13.3 (0.6)^a	<0.0001
IL-8 (pg/ml)	T0	11.6 (0.7)	11.7 (0.6)	11.8 (0.8)	0.670
	T1	11.5 (0.7)	11.5 (0.6)	11.4 (0.6)	0.848
	T2	11.7 (0.5)	11.3 (0.6)	11.0 (0.5)	0.0005
	T3	16.8 (0.80	16.7 (0.6)	32.3 (0.7)^a	<0.0001
	T4	15.4 (0.6)	15.5 (0.7)	33.2 (0.7)^a	<0.0001
	T5	15.2 (0.5)	14.9 (0.6)	33.6 (0.6)^a	<0.0001

Data are presented as mean (SD).

IL-6, interleukin-6; IL-8, interleukin-8; MDA, malonyldialdehyde; T0, baseline (T0); T1, 1 min after tourniquet placement; T2, 1 min before tourniquet release; T3, 5 min after tourniquet release; T4, 20 min after tourniquet release; T5, 1 h after tourniquet release.

p-value < 0.001 vs. Group A and Group N.

able 3 Total dose of ephedrine.

Variable	Group A (N = 20)	Group N (N = 20)	Group C (N = 20)	p-value
Total dose of ephedrine before tourniquet release (mg)	10.2 (3.3)	9.9 (4.1)	10.1 (3.8)	0.967
Total dose of ephedrine after tourniquet release (mg)	4.3 (1.4)	4.1 (1.5)	7.6 (2.0)^a	<0.0001

Data are presented as mean (SD).

P-value < 0.001 versus Group A and Group N.

igure 1 Changes in pH in the three study groups. Error bars represent SD. T0, baseline (T0); T1, 1 min after tourniquet placement; T2, 1 min before tourniquet release; T3, 5 min after tourniquet release; T4, 20 min after tourniquet release; T5, 1 h after tourniquet release.

igure 2 Changes in serum lactate in the three study groups. Error bars represent SD. T0, baseline (T0); T1, 1 min after tourniquet placement; T2, 1 min before tourniquet release; T3, 5 min after tourniquet release; T4, 20 min after tourniquet release; T5, 1 h after tourniquet release.