Lower Tourniquet Cuff Pressures

Lower tourniquet cuff pressure reduces postoperative wound complications after total knee arthroplasty

Posted on March 4, 2013. Filed under: Lower Tourniquet Cuff Pressures, Tourniquet Safety | Tags: , , , |

An interesting paper from the Södersjukhuset Karolinska Institutet, in Stockholm Sweden evaluating the benefit of measuring limb occlusion pressure before surgery was recently published in the December 2012 issue of the Journal of Bone and Joint Surgery [1].

This randomized controlled study of 164 patients demonstrated a significant reduction in tourniquet pressure and more individual cuff pressures among patients when LOP was measured using 140 mm wide contour cuffs.  Although the study method demonstrated no difference in postoperative pain between the LOP and control groups, the authors note that patients with cuff pressures below 225 mmHg had fewer postoperative complications.

The full abstract of the publication in the Journal of Bone and Joint Surgery is given below. [1]

Background: Measurement of limb occlusion pressure before surgery might lead to the use of a lower tourniquet cuff pressure during surgery and thereby reduce the risk of postoperative pain and complications. The primary aim of this study was to investigate whether the limb-occlusion-pressure method reduces the tourniquet cuff pressure used during total knee arthroplasty and if this leads to less postoperative pain compared with that experienced by patients on whom this method is not used. The secondary aim was to investigate whether there were any differences regarding the quality of the bloodless field, range of motion, and postoperative wound complications.

Methods: One hundred and sixty-four patients scheduled to be treated with a total knee arthroplasty were randomized to a control group or to undergo the intervention under study (the limb-occlusion-pressure [LOP] group). In the control group, the tourniquet cuff pressure was based on the patient’s systolic blood pressure and a margin decided by the surgeon (the routine method). In the LOP group, the tourniquet cuff pressure was based on the measurement of the limb occlusion pressure. The primary outcome measure was postoperative pain, and the secondary outcome measures were the quality of the bloodless field, knee motion, and wound-related complications at discharge and two months after surgery.

Results: The tourniquet cuff pressure was significantly lower in the LOP group than in the control group (p < 0.001). We could not demonstrate any differences between the groups regarding postoperative pain or complications, although the number of postoperative complications was relatively high in both groups. However, at discharge forty of the forty-seven patients with a wound complication had had a cuff pressure above 225 mm Hg and at the two-month follow-up evaluation fourteen of the sixteen patients with a wound complication had had a cuff pressure above 225 mm Hg.

Conclusions: The limb-occlusion-pressure method reduces the cuff pressure without reducing the quality of the bloodless field, but there were no differences in outcomes between the groups. An important secondary finding was that patients with a cuff pressure of 225 mm Hg had no postoperative infections and a lower rate of wound complications.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

References

[1] Olivecrona C, Ponzer S, Hamberg P, Blomfeldt R (2012) Lower tourniquet cuff pressure reduces postoperative wound complications after total knee arthroplasty: a randomized controlled study of 164 patients. J Bone Joint Surg Am 94:2216–2221

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