Comparison of lower limb lifting and squeeze exsanguination before tourniquet inflation during total knee arthroplasty

Zhang, Meng; Liu, Gang; Zhao, Zhongwei; Wu, Pengfei; Liu, Weidong

doi:10.1186/s12891-019-2406-6

Cited by 6 publications

(1 citation statement)

References 30 publications

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“…“However, the literature supports elevation alone to decrease pain in patients undergoing tourniquet‐assisted procedures without general anesthesia and supports the potential of elevation alone requiring less time compared with mechanical exsanguination.” Unless contraindicated, elastic wrap may be used for exsanguination, although additional research regarding the benefits and harms of this approach is needed 1,9 . Use of the hand‐over‐hand technique should be avoided 1,10 …”

Section: Application and Inflationmentioning

confidence: 99%

Guideline for pneumatic tourniquet safety

Croke¹

2020

AORN Journal

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Section: Application and Inflationmentioning

confidence: 99%

Guideline for pneumatic tourniquet safety

Croke¹

2020

AORN Journal

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Enhanced recovery after surgery protocols in total knee arthroplasty via midvastus approach: a randomized controlled trial

Wei

Tang

et al. 2021

BMC Musculoskelet Disord

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Background Enhanced recovery after surgery (ERAS) protocols were rapidly adopted in many surgeries such as fast-track arthroplasty. The study aimed to investigate the impact of ERAS protocols on the clinical effect of total knee arthroplasty (TKA) via the midvastus approach. Methods A total of 69 patients who underwent primary unilateral TKA via the midvastus approach from October 2018 to June 2019 were enrolled and randomly divided into two groups: ERAS group and Control group. The ERAS protocols were adopted for the ERAS group and consisted of pure juice drinking 2 h before the surgery, optimization of the preoperative anesthesia plan, phased use of tourniquets, and the use of tranexamic acid as well as a drug cocktail. The operative time, first postoperative walking time, first straight leg elevation time, postoperative hospitalization time, visual analogue scale score (VAS score), Hospital for Special Surgery score (HSS score), conventional Knee Society score (KSS), and knee range of motion (ROM) were used to assess the clinical effects in the two groups. All the included patients were followed up for 12 months. Results There were no significant differences in the basic demographic information and operation time between the ERAS and Control groups (P > 0.05). The first postoperative walking time (2.11 ± 0.11 h) and first postoperative straight leg elevation time (6.14 ± 1.73 h) in the ERAS group were significantly earlier than those in the Control group (P < 0.001) and the postoperative hospitalization time was significantly shorter (3.11 ± 0.32 days). The postoperative mean VAS scores in both groups were significantly reduced compared with those before surgery (P < 0.001). The VAS scores for the ERAS group were significantly lower than those for the Control group at 1, 2, and 7 days after surgery (P < 0.001). The mean HSS scores, KSS, and knee ROM were significantly increased in both the ERAS and Control groups at 1, 3, 6, and 12 months after surgery (P < 0.001). In addition, the HSS scores, KSS, and knee ROM in the ERAS group were significantly higher than those in the Control group at 1 month after surgery (P < 0.001). Conclusions ERAS protocols improved the clinical effects of TKA via the midvastus approach, facilitating early out-of-bed activity and comfortable postoperative rehabilitation exercise, and further increasing patient satisfaction. Trial registration ClinicalTrials.gov Identifier: NCT04873544.

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Randomised controlled trial of tourniquet associated pain generated in lower limb after exsanguination by Esmarch bandage versus limb elevation

Mitrichev,

Maunder,

Jabur

et al. 2024

J Orthop Surg Res

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Background Tourniquets are common adjuncts in the operating theatre but can be associated with post-operative pain. This study was designed to compare what effect pre-tourniquet Esmarch bandage exsanguination has on pain, compared to pre-tourniquet exsanguination by elevation alone. Methods 52 volunteers (104 lower limbs) were included in this study with each volunteer acting as their own matched control. The primary outcome was patient reported pain, measured in both legs simultaneously using area under curve. Secondary outcomes were pain score during inflation and deflation, cumulative pain score, duration of recovery and blood pressure during testing. Results Pain after Esmarch was superior to elevation as measured by area under pain curve (68.9 SD 26.1 vs 77.2 SD 27.3, p = 0.0010), independent of leg dominance. Cumulative pain scores demonstrated the same superiority after inflation (50.7 SD 17.1 vs 52.9 SD 17.0, p = 0.026) but not after deflation (p = 0.59). Blood pressure was not significantly different. Time to full recovery of the lower limb was the same for both groups—7.6 min (SD 2.1 min, p = 0.80). Conclusion Previous studies describe a positive effect on pain when Esmarch bandage was used prior to tourniquet inflation for upper limb. Our findings suggest the same benefit from Esmarch when it was used on lower limbs—particularly during inflation of tourniquet. In addition to pain profiles, surgeon preference and patient factors need to be considered when deciding between elevation and Esmarch bandage.

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Comparison of lower limb lifting and squeeze exsanguination before tourniquet inflation during total knee arthroplasty

Cited by 6 publications

References 30 publications

Guideline for pneumatic tourniquet safety

Guideline for pneumatic tourniquet safety

Enhanced recovery after surgery protocols in total knee arthroplasty via midvastus approach: a randomized controlled trial

Randomised controlled trial of tourniquet associated pain generated in lower limb after exsanguination by Esmarch bandage versus limb elevation

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