Application effect of pneumatic tourniquet with individualized pressure setting in orthopaedic surgery of extremities: A meta‐analysis

Abstract

Aims To evaluate the application effect of individualized pressure setting strategy of pneumatic tourniquet in orthopaedic surgery. Background Some individualized setting pressures of pneumatic tourniquet are lower than the standard pressure recommended in the textbook (Nursing of Operating Room, People's Military Publishing House, 2008). Design Meta‐analysis. Data Sources CL, WOS, PubMed, CNKI, CBM, VIP and Wan‐fang DATA. Review Methods We searched studies on the application effect of individualized pressure of pneumatic tourniquet from the establishment date of the databases to September 2017. Study quality was assessed using the quality evaluation method recommended in the Cochrane Handbook 5.1.0 (Higgins, 2011). The primary outcome was inflation pressure. Results We identified nine studies including 1,200 patients. The individualized pressure setting strategy can provide a lower inflation pressure (four studies), improve haemostatic effect (six studies) and reduce the incidence of related complications (eight studies). Conclusions An individualized inflation pressure is recommended when using the tourniquet in orthopaedic surgery. And the setting pressure might be a minimum and efficiency one, by accessing the the systolic blood pressure and limb circumferences of the patient. Impact This study addressed that the individualized pressure setting strategy of pneumatic tourniquet can provide a lower inflation pressure and a higher application value in orthopaedic limb surgery. However, greater attention should be focused on how to unify the individualized pressure setting strategy. Meanwhile, the instructions for use from manufacturers need to be updated. Therefore, it is recommended to conduct a large‐sample multi‐centre high‐quality randomized controlled trial in strict accordance with the CONSORT standard.

Knowledge, attitudes, and practices of orthopedic operating room personnel regarding the use of pneumatic tourniquets

“…The questionnaire design was based on previously published literature regarding the safe application of PTs in orthopedic surgery [ 3 , 19 ], as well as specialized guidelines for PT safety [ 2 , 20 ]. After designing, the questionnaire underwent internal discussions, followed by appropriate revisions.…”

“…Pneumatic tourniquets (PTs) are innovative hemostatic tools for creating a bloodless surgical field by applying appropriate pressure to constrict blood vessels [ 1 , 2 ]. In orthopedic operating rooms, PTs are widely used to reduce intraoperative bleeding and prepare the optimal operating field, as well as to promote safety when administering regional anesthesia [ 3 , 4 ]. However, perioperative PTs application may induce an ischemia-reperfusion injury leading to adverse local and systemic consequences [ 5 ]; the incidence of such complications can be minimized by careful patient evaluation and adherence to the safe principles of PTs use [ 3 , 6 ].…”

A systematic review of tourniquet use in paediatric orthopaedic surgery: can we extrapolate from adult guidelines?

“…Studies in the adult population have attempted to elucidate techniques for the safer use of tourniquets. Example of such methods include adjusting inflation pressures to the patient’s systolic blood pressure (SBP) and limb occlusion pressure (LOP) ( 23 , 24 , 25 ) as well as choosing wider, contoured cuffs ( 26 , 27 , 28 ). Omitting the use of tourniquets altogether has gained momentum.…”