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.
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http://dx.doi.org/10.1186/s12891-019-2636-7 | DOI Listing |
BMC Emerg Med
January 2025
Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, CNY149, 13th St, Charlestown, 02129, MA, USA.
Background: The use of emergency tourniquets among military personnel has helped to dramatically reduce battlefield deaths and has recently gained popularity in the civilian sector. Yet, even well-trained individuals can find it difficult to assess proper tourniquet application. Emergency tourniquets are typically deemed sufficiently tightened through cursory visual confirmation or pulse assessment.
View Article and Find Full Text PDFJ Hand Surg Glob Online
November 2024
Hand and Microsurgery Unit, Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangasaan Malaysia, Kuala Lumpur, Malaysia.
Purpose: Fixation of metacarpal or phalanx bone fractures is usually performed under general anesthesia (GA) or regional anesthesia and with the use of a tourniquet to minimize bleeding. However, the use of tourniquet causes pain and discomfort after surgery. Wide-awake local anesthesia no tourniquet (WALANT) enables the surgery to be performed with the patient fully awake and without a tourniquet, which allows intraoperative assessment of function during surgery.
View Article and Find Full Text PDFFront Physiol
December 2024
Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.
J Anesth
December 2024
Department of Advancing Acute Medicine, Nagoya City University Graduate School of Medical Sciences and Medical School, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 467-8601, Japan.
Purpose: A peripherally inserted central catheter (PICC) placement often requires ultrasound guidance. Previous studies using an adult blood pressure cuff have suggested that veins do not easily collapse at the tourniquet pressure from diastolic to systolic blood pressure. When inserting a PICC into the basilic vein of the upper arm, a narrow blood pressure cuff should be used as a tourniquet to avoid concealing the puncture site.
View Article and Find Full Text PDFArthroscopy
December 2024
Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai City, Zhejiang Province, China. Electronic address:
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