Is lower tourniquet pressure during total knee arthroplasty effective? A prospective randomized controlled trial

Abstract

Background Higher tourniquet pressures may be associated with an increased risk of complications. We aimed to determine (1) whether a lower tourniquet pressure [systolic blood pressure (SBP) + 120 mmHg] is as effective as conventional tourniquet pressure (SBP + 150 mmHg) in providing a bloodless surgical field and decreasing blood loss, and (2) whether lowering the tourniquet pressure decreases tourniquet-related complications compared to conventional inflation pressure. Methods One hundred and sixty knees in 124 patients undergoing total knee arthroplasty (TKA) were randomly allocated to either conventional ( n = 80) or lower inflation pressure group ( n = 80). The quality of the initial surgical field and occurrence of intraoperative blood oozing, hemoglobin drop, drained volume and calculated blood loss were assessed as efficacy variables. Safety outcome variables included post-operative pain, tourniquet site skin problems (ecchymosis, bullae, skin necrosis), and other tourniquet-related complications such as nerve palsy, venous thromboembolism, and delayed rehabilitation. Results A comparable bloodless surgical field was successfully provided in both groups (100% vs. 99%, p = 1.000). One case in the conventional pressure group and two cases in the lower pressure group showed intraoperative blood oozing ( p = 1.000), which was successfully controlled after an increase of 30 mmHg in the tourniquet inflation pressure. There was no difference in the hemoglobin drop, drained volume, and calculated blood loss. The two groups did not differ in any safety outcomes such as post-operative pain, thigh complications, and other tourniquet related complications. Conclusion This study demonstrates that a tourniquet inflation pressure of 120 mmHg above the SBP is effective method during TKA. Trial registration The trial was with ClinicalTrials.gov ( NCT01993758 ) on November 25, 2013.

Development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplasty

“…Several strategies have been used to reduce the risk for transfusion in TKA patients, such as the use of a tourniquet and tranexamic acid [8,9]. Unfortunately, the side effects of these strategies continue to worry orthopedists, and some patients still need blood transfusions.…”

The effect of limited versus no tourniquet use on rapid recovery in total knee replacement--a randomized controlled trial

“…It is well-known that pain is an important in uencing factor for patients' satisfaction with surgery. In the trial, the same enhanced recovery after surgery and postoperative rehabilitation training were used in all groups [27,28]. The analysis of the results showed that the visual analogue scale at 1, 3 and 7 d after the second half of tourniquet application was signi cantly greater than that in the other two groups.…”

<p>Protective Effects of Rocuronium Bromide on Ischemia-Reperfusion Injury in Skeletal Muscle Induced by Tourniquet in Patients Undergoing Elective Unilateral Total Knee Arthroplasty: A Prospective, Double Blind, Randomized, Controlled Study</p>

“…Automatic pneumatic tourniquet (Changzhou yanling co. LTD) was tied to the upper and middle thigh with inflating pressure as the SBP+150 mmHg. 13 Tourniquet was inflated before skin incision and deflated after implant. Then, the incision was closed after safe hemostasis.…”

“…Both NOSI/ nNOS and NOSIII/eNOS are related to the maintenance of adequate micro-vascular blood flow and the regulation of skeletal muscle function. 11 There is evidence that the degree of muscle injury caused by IRI is closely related to the duration of ischemia, 12 tourniquet inflation pressure, 13 and mode. 14 Therefore, surgeons often try to shorten the time of ischemia, reduce the pressure of the tourniquet, and change the method of using tourniquets in order to reduce the IRI of skeletal muscle of the operated limb.…”