The deleterious effects of exsanguination with a tight bandage on tourniquet tolerance in the upper arm

Tanpowpong, Thanathep; Kitidumrongsook, Pravit; Patradul, Adisorn

doi:10.1177/1753193412442288

Cited by 7 publications

(6 citation statements)

References 12 publications

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“…In the present study, another important interesting finding was the significant decrease of VAS score in the lower limb lifting group. Tanpowpong et.al [17] compared the effect of tight elastic bandaging and limb lifting exsanguination on upper extremity in 23 healthy adult volunteers. It demonstrated that the tourniquet tolerance was significantly lower in bandaging group.…”

Section: Discussionmentioning

confidence: 99%

“…In order to identify an optimal exsanguination method, a few clinical studies have been conducted to compare the effect of different preoperative exsanguination methods on the clinical outcomes. Blond et.al [15] compared different exsanguination methods of the upper limb in healthy young volunteers, and concluded that the squeeze method was the best before inflation of a tourniquet; Tanpowpong et.al [17] found a significant lower tourniquet tolerance of exsanguination with a tight bandage compared to lifting method in the upper arm; Farbood et.al [16] focused on the Esmarch bandage and limb lifting of the upper extremity and found the limb lifting technique produced less discomfort for patients; Angadi et.al [18] investigated the use of Rhys-Davies mechanical exsanguination and limb lifting method in knee arthroscopy, and found that lower limb lifting was an effective technique of exsanguination prior to knee arthroscopy. These studies were mostly related to upper limb combined with various diversities and conflict conclusions, which limited the application of the clinical findings.…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Liu

Zhao

et al. 2019

BMC Musculoskelet Disord

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BackgroundDuring total knee arthroplasty(TKA), tourniquet is widely used by most surgeons whereas the optimal application is still controversial. With this prospective randomized controlled study, we intend to investigate the effect of lower limb lifting and squeeze exsanguination methods on clinical outcomes in a series of TKAs.MethodsProspectively enrolled a total of 236 TKA patients from March, 2012 to November, 2016. Of which 118 patients randomly constitute Group A with lower limb lifting exsanguination technique; and the other 118 patients comprise Group B with squeeze exsanguination method. A year’s follow-up measurements were recorded in detail for analysis.ResultsThe pre-tourniquet time of Group A was significantly shorter than that in Group B (P < 0.001). Significant difference was found on skin tension blister, 3 happened in Group A and 11 happened in Group B (P = 0.031), which resulted in a difference in total complications (P = 0.039). The VAS score was significantly lower in Group A at one and seven days postoperatively, P < 0.001 and P = 0.011, respectively. No significant differences were found regarding all other clinical outcome measurements.ConclusionThe lower limb lifting exsanguination is a safe and effective technique. Compared with squeeze exsanguination method, it could decrease the incidence of skin tension blister and alleviate early postoperative pain reaction, no additional risks occurred regarding other clinical outcomes. Thus, it might have the potentiality to be commonly utilized in TKA procedure.Trial registrationClinicalTrials.gov Identifier: ChiCTR1800020471. Registered on 31 December 2018 Retrospectively registered.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Zhang

Liu

Zhao

et al. 2019

BMC Musculoskelet Disord

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“…We acknowledge that there are several other commercially available tourniquet types and techniques that have not been examined. Despite this variability in local pressures, patients are usually pain free during procedures where digital tourniquets are applied under local anaesthetic, in comparison with upper arm tourniquets (Smith et al, 2012; Tanpowpong et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Variability in local pressures under digital tourniquets

Middleton

Jenkins

Muir

et al. 2013

J Hand Surg Eur Vol

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The UK National Patient Safety Agency issued a rapid response report in 2009 following reports of complications related to digital tourniquet use and inadvertent retention. In their guidance, they recommend the use of CE marked digital tourniquets and advise against the use of surgical gloves. There are a number of different commercially available non-pneumatic digital tourniquets, but little clear data relating to their comparable physical properties, clinical efficacy or safety. The aim of this study was to investigate the variability of pressures exerted by non-pneumatic digital tourniquets. A Tekscan FlexiForce(®) force sensor was used to measure applied force and to calculate the surface pressures under: the Toe-niquet™; T-Ring™ and surgical glove 'roll down' tourniquets in finger models. The lowest mean pressures were produced by the larger glove sizes (size 8) (25 mmHg), while the highest pressures were produced by the Toe-niquet (1560 mmHg). There was a significant overall difference in pressures exerted under tourniquets when comparing tourniquet type (p<0.001) and finger size (p<0.001) with these techniques. It is difficult to anticipate and regulate pressures generated by non-pneumatic tourniquets. Safe limits for application time and surface pressures are difficult to define. Further work is required to model the pressure effects of commercially available digital tourniquets and to identify which are most effective but safe.

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“…This method is simple, cost‐effective, safe, and fomite‐free . Supporting this approach, a recent study reports that tourniquet is better tolerated by healthy adult volunteers when exsanguination is achieved by limb elevation than by elastic bandage (average 24.1 minutes vs. 19.4 minutes) . However, studies using quantitative assessments indicate that exsanguination with brachial artery compression and limb elevation is not as effective as Esmarch bandage in reducing the blood volume of the upper limbs .…”

Section: Exsanguination Techniques Before Pneumatic Tourniquet Inflationmentioning

confidence: 99%

Pneumatic Tourniquet for Surgical Procedures of Hemodialysis Vascular Access

Wang

2014

Seminars in Dialysis

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Pneumatic tourniquet has been frequently utilized in various surgical specialties to facilitate surgical procedures on the extremities. However, its use for surgical procedures of hemodialysis access has been limited to some surgeons in the United States and often confined to the hospital settings under general anesthesia or regional nerve block. We have successfully employed a pneumatic tourniquet system for surgical procedures of hemodialysis access under conscious sedation and local anesthesia in an outpatient setting. Because prolonged tourniquet inflation is associated with ischemic pain and other potential complications, we have limited the continuous inflation time to <30 minutes. Our recent data from 550 surgical procedures of hemodialysis access have emphasized that pneumatic tourniquet use is well tolerated under conscious sedation and not associated with significant adverse events. These and other reported data suggest that pneumatic tourniquet can reduce procedure time, minimize required dissection, reduce vascular trauma by eliminating vascular clamps and potentially improve the outcomes of surgical procedures of hemodialysis access. These advantages may be translated into cost savings for hemodialysis access care. This review discusses practical issues of pneumatic tourniquet use and its applications in surgical procedures of hemodialysis access.

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The deleterious effects of exsanguination with a tight bandage on tourniquet tolerance in the upper arm

Cited by 7 publications

References 12 publications

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

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

Variability in local pressures under digital tourniquets

Pneumatic Tourniquet for Surgical Procedures of Hemodialysis Vascular Access

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