Comparison of local pain and tissue reaction between conventional pneumatic tourniquet and disposable silicone ring tourniquet during Total Knee Arthroplasty

Abstract

Background: To study the comparison of conventional pneumatic and disposable silicone ring tourniquet in Total Knee Arthroplasty. Material and methods: This is a prospective randomized control trial. We used conventional pneumatic tourniquet on one side of leg and disposable silicone ring tourniquet on the other side in consecutive 50 simultaneous bilateral TKR patients. Patients having peripheral vascular disease of the lower limb were excluded from the study. The patient demographics & characteristics are identical being the same patient with two different legs. We started the study with null hypothesis. An independent observer assessed the local tourniquet site pain (VAS score 1e10) and local tourniquet site skin reaction at 24 h and 48 h after the TKA. P value < 0.05 was considered significant. Results: There were no local skin complication with disposable tourniquet (0%). 8 out of 50 patients in whom the conventional tourniquet was applied showed local bruising, and two patients had blister formation making the local skin site complication rate 20% (statistically significant, p value0.0196, chisquared test). The VAS score at 24 h was 4.3 ± 1.5 for disposable tourniquet group as against 5.6 ± 2.1 for conventional tourniquet group (statistically significant, p value ¼ 0.0152, t statistic test for comparison of means). The VAS score at 48 h was 2.1 ± 1.5 and 3.3 ± 1.2 for disposable tourniquet group and conventional tourniquet group respectively (statistically significant p value ¼ 0.003, student's t-test). Conclusion: Use of disposable tourniquet has better outcome than the conventional tourniquet with minimal or no local complications. The advantages of the disposable tourniquet are: 1 less local pain, 2. no local skin problems, 3. accurate tourniquet pressure at the application site, 4.0% local contamination. Hence, we recommend use of the disposable tourniquet during the Total Knee Arthroplasty.

Silicone ring tourniquet could be a substitute for a conventional tourniquet in total knee arthroplasty with a longer surgical field: a prospective comparative study in simultaneous total knee arthroplasty

“…Jenny et al [ 10 ] showed a decreased rate of skin complications with silicon ring tourniquet despite no significant change in the calculated blood loss. Sanjay et al [ 23 ] showed that the advantages of the silicone ring tourniquet include less local pain, no local skin problems, and accurate tourniquet pressure at the application site. Of 50 patients in whom the conventional tourniquet was applied, 8 showed local bruising, and 2 had blister formation, resulting in a local skin site complication rate of 20%.…”

Widening Access: Sterile Tourniquets for Surgery to the Distal Humerus

“…It is believed to reduce the risk of contamination by reducing the need to extend incisions close to the edges of the sterile field while increasing sterile exposure [ 4 ]. It has also been found that the use of the SET in total knee arthroplasty was associated with reduced intra-operative bleeding and post-operative bleeding into drains, a smaller fall in haemoglobin, and a lower rate of wound infection postoperatively [ 4 , 16 , 17 ].…”

“…Three studies reported that participants experienced less pain and soft tissue reaction with the use of a sterile elastic tourniquet to the upper arm, compared to a pneumatic tourniquet, along with a reduced incidence of paraesthesia postoperatively [ 1 , 17 , 18 ]. The use of the narrower sterile silicone elastic tourniquet has also been reported to provide an improved fit for patients with tapered or conical-shaped limbs, particularly paediatric patients, in which traditional pneumatic tourniquets were more liable to slip distally, reducing the effectiveness of arterial occlusion and impeding sterility.…”

Silicone ring tourniquet could be a substitute for a conventional tourniquet in distal femur surgeries with a longer surgical field: A prospective comparative study in simultaneous total knee arthroplasty

“…Jenny et al [10] showed a decreased rate of skin complications with silicon ring tourniquet despite no signi cant change in the calculated blood loss. Sanjay et al [22] showed that the advantages of the silicone ring tourniquet include less local pain, no local skin problems, and accurate tourniquet pressure at the application site. Of 50 patients in whom the conventional tourniquet was applied, 8…”