Effect of Tourniquet Time on Postoperative Quadriceps Function

Saunders, Karl C.; Louis, D; Weingarden, Saul I.; Waylonis, George W.

doi:10.1097/00003086-197909000-00034

Cited by 91 publications

(101 citation statements)

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“…Previous studies have also demonstrated electromyographic abnormalities in over 70% of upper and lower extremity surgeries after tourniquet use [9,28]. These EMG changes persisted up to 6 months after tourniquet use, and were associated with decreased postoperative function [9,28,39]. …”

Section: Introductionmentioning

confidence: 91%

Ischemic‐preconditioning does not prevent neuromuscular dysfunction after ischemia–reperfusion injury

Eastlack

Groppo

Hargens

et al. 2004

Journal Orthopaedic Research

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The primary purpose of this study was to evaluate ischemic‐preconditioning (IPC) as a means of improving tolerance to ischemia–reperfusion (IR) stress on neuromuscular function. A secondary objective was to isolate the area of injury within the neuromuscular unit responsible for contractile dysfunction after IR injury. Twenty‐eight male rabbits were randomly assigned to four groups (sham, IPC only, sustained ischemia only, IPC and sustained ischemia). The IPC protocol consisted of three cycles of 10 min of tourniquet‐induced ischemia (125 mmHg) followed by 10 min of reperfusion. Sustained ischemia was induced by 350 mmHg external compression for 2 h. Peak tetanic tension of the tibialis anterior (TA) muscle was evaluated 48 h after the tourniquet protocol by both peroneal nerve and direct muscle stimulation, with and without pharmacologic neuromuscular junction blockade. Animals subjected to combined IPC and sustained ishemia had an equivalent loss of contractile force to those undergoing sustained ischemia alone. Two hours of tourniquet‐induced ischemia resulted in marked dysfunction of the TA neuromuscular unit when evaluated by peroneal nerve stimulation (p < 0.0001). Isolation of the TA muscle from the peroneal nerve with direct muscle stimulation and neuromuscular junction blockade preserved muscle function after 3 h of ischemia. In our model, these results clearly demonstrate that IPC provides no significant protective effect from IR injury to either nerve or muscle function in our model. In addition, nerve or neuromuscular junction injury, rather than muscle damage, is identified as primarily responsible for IR‐related muscle dysfunction. © 2003 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.

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Section: Introductionmentioning

confidence: 91%

Ischemic‐preconditioning does not prevent neuromuscular dysfunction after ischemia–reperfusion injury

Eastlack

Groppo

Hargens

et al. 2004

Journal Orthopaedic Research

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“…Several randomized controlled trials of tourniquet versus no tourniquet use during this operation have shown no statistical difference or even less total blood loss when no tourniquet is used [1,2,10,12,14,15,[25][26][27][28][29] . Moreover, there are potential complications associated with tourniquet use: nerve palsy [8,19], delayed recovery of muscle power from microscopic changes in muscle myofibrils [21], wound complications [1,12,25], and venous thrombotic embolism [1,10,12]. Deflation of the tourniquet can cause respiratory and cardiac complications in patients with poor cardiac function [7,18].…”

Section: Introductionmentioning

confidence: 99%

Tourniquet Use During Cementation Only During Total Knee Arthroplasty: A Randomized Trial

Tarwala

Dorr

Gilbert

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Total knee arthroplasty with the use of a tourniquet during the entire operation has not been shown to improve the performance of the operation and may increase the risk of complications. Questions/purposes We asked whether the limited use of a tourniquet for cementation only would affect (1) surgical time; (2) postoperative pain and motion of the knee; (3) blood loss; or (4) complications such as risk of nerve injuries, quadriceps dysfunction, and drainage compared with use of a tourniquet throughout the procedure. Methods Seventy-one patients (79 knees) were randomized to either use of a tourniquet from the incision through cementation of the implants and deflated for closure

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“…Postoperative weakness of the quadriceps femoris muscle after operations using pneumatic tourniquet are common and the weakness has been attributed to axonal compression syndrome [2]. The patient described here is an extreme example: a nearly total bilateral postoperative paresis of the quadriceps femoris muscles for two months and a gradual improvement thereafter.…”

Section: Discussionmentioning

confidence: 76%

“…However, the use of a tourniquet may cause hemodynamic, metabolic or local complications [1]. Some patients suffer from postoperative thigh weakness, especially when a high tourniquet pressure and long tourniquet time are used [2]. In a systematic ENMG study of patients with anterior crucial ligament operations with tourniquet, the changes in neurography were slight, when pre-and post-operative investigations were compared.…”

Section: Introductionmentioning

confidence: 99%

Tourniquet Paralysis may Reflect Injury of Muscle Spindles

Partanen¹

2017

J Neurol Neurophysiol

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Objective: Knee operation using pneumatic tourniquet may cause weakness of the quadriceps femoris muscle. A patient with a paresis of the quadriceps femoris muscle for two months postoperatively was studied. Methods: ENMG and lumbar magnetic stimulation (MEP) follow-up.Results: There was no distinct lesion of the motor axons of the femoral or other nerves in ENMG or MEP six weeks postoperatively. After a follow-up of eight months, the paresis was subsided and a complete recovery took place in two years. Conclusion:High pressure of the tourniquet may injure muscle spindles. Decreased Ia-afferent activity may severely inhibit voluntary motor effort.

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Effect of Tourniquet Time on Postoperative Quadriceps Function

Cited by 91 publications

References 0 publications

Ischemic‐preconditioning does not prevent neuromuscular dysfunction after ischemia–reperfusion injury

Ischemic‐preconditioning does not prevent neuromuscular dysfunction after ischemia–reperfusion injury

Tourniquet Use During Cementation Only During Total Knee Arthroplasty: A Randomized Trial

Tourniquet Paralysis may Reflect Injury of Muscle Spindles

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