The impact of exsanguination by Esmarch bandage on venous hemodynamic changes in total knee arthroplasty — A prospective randomized study of 38 knees

Chiu, Fang-Yao; Hung, Shih-Hsin; Chuang, Tien-Yow; Chiang, Shu Chiung

doi:10.1016/j.knee.2011.03.005

Cited by 9 publications

(4 citation statements)

References 17 publications

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“…The majority of these are from orthopaedic trauma cases, however some were recorded for elective cases such as total knee arthroplasty (TKR) [19]. In light of this potentially fatal outcome, some authors recommend against the use of Esmarch bandage for exsanguination in TKR [23,24], knee arthroscopy [24], and trauma cases, particularly where there has been a delay for surgical treatment [18].…”

Section: Discussionmentioning

confidence: 99%

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

Preprint

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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 acted as their own matched control. The primary outcome was pain level, measured in both legs simultaneously using visual analogue scale every 2 minutes for 20 minutes of tourniquet inflation and every minute after deflation. Secondary outcomes were pain difference, cumulative pain score, time of recovery and blood pressure during occlusion and release time. Results There was no statistically significant difference in cumulative pain score between legs regardless dominance, site of investigation and point of time. There was no difference in cumulative pain scores between Esmarch and elevation under inflation (50.6, SD 17.0 vs 51.7, SD 16.8, p = 0.87) or deflation (23.4, SD 14.8 vs 24.1, SD 14.9, p = 0.94). Time to full recovery of the lower limb was the same for both groups — 7.6 minutes (SD 2.1min, p = 0.80). Conclusion Previous studies describe a positive effect on pain when Esmarch bandage was used prior to tourniquet inflation for upper limb. Using a high level of evidence, we could not prove the same benefit from Esmarch when it was used on lower limbs during inflation of tourniquet, nor after release. These two techniques yield similar pain profiles, and patient factors need to be considered when deciding between elevation and Esmarch bandage.

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Section: Discussionmentioning

confidence: 99%

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

Preprint

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“…have shown that Esmarch bandage decreases the venous flow in the postoperative period. 18 All patients with DVT were reviewed by physicians in cardiac and vascular surgery, and their risk analyses were performed. Of the patients who were recommended for anticoagulant treatment, four underwent the planned surgical treatment, and two cases were canceled.…”

Section: Discussionmentioning

confidence: 99%

Should venous doppler ultrasonography be routinely applied before lower extremity major orthopedic surgery?

Göçer

Yazici²,

Polat

2017

Niger Med J

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Background:Hip-knee arthroplasty and knee arthroscopy (KA) is frequently applied in the orthopaedic surgery. The approach does not exist related with the preoperative asymptomatic deep venous thrombosis (DVT). In this study, the patients who would undergo surgery lower extremity were screened for asymptomatic DVT, using the venous Doppler ultrasonography (USG).Patients and Methods:DVT was screened by venous Doppler USG in the patients who would undergo hip-knee arthroplasty and KA between the dates of November 2013 and September 2015. The patients were investigated regarding the age, gender, and the planned operation. The cases were separated to the following three groups: group I (<49 years), Group II (49–69 years), and Group III (≥70 years).Results:The study included 222 patients; of these, 174 were female and 48 were male. Group I, Group II, and Group III included 45, 115, and 62 patients, respectively. Of the six patients determined to exist with DVT, 2 (1.73%) were in Group II, and 4 (6.45%) were in Group III.Conclusion:Although the differences were not found to be statistically significant, it may be useful to screen asymptomatic DVT by Doppler USG in the preoperative period in the 70-year-old male patients, and in those over 70.

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“…[17] Another recent study has demonstrated that better leg hemodynamic changes were attained during the first month after knee arthroplasty in patients where Esmarchwas not used. [18] The use of Esmarch did reduce arterial flow to the lower limb for a longer period of time, hence raising the question about the need for exsanguination with Esmarch bandage before elective knee procedures. In a meta-analysis of elective knee procedures, it was shown that even though intraoperative loss of blood was significantly greater in the nontourniquet group compared to tourniquet-assisted surgery, there was no significant difference between the groups for total loss of blood or rate of transfusion.…”

Section: Discussionmentioning

confidence: 99%

Fatal pulmonary embolism subsequent to the use of Esmarch bandage and tourniquet: A case report and review of literature

et al. 2013

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We report a case of fatal pulmonary embolism (PE) following exsanguinations of lower limb in orthopedic surgery. A 30-year-old man was posted for fixation of a tibial plateau fracture on the seventh day after injury. Subarchnoid block was performed. Esmarch bandage was used for exsanguination of the limb and tourniquet was inflated. Within three minutes after tourniquet inflation, the patient became unconscious hypotensive, and collapsed. Resuscitation was instituted and spontaneous circulation restored. Right ventricular strain pattern on transthoracic echocardiography, increased levels of D-dimer, and Doppler examination of the lowerlimb confirmed deep venous thrombosis of right femoral vessels and PE. In spite of thrombolytic therapy with streptokinase and heparin, the patient died on the ninth day after the event. Cases of PE secondary to the use of Esmarch bandage and tourniquet are reviewed here to identify the risk groups and management of PE.

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The impact of exsanguination by Esmarch bandage on venous hemodynamic changes in total knee arthroplasty — A prospective randomized study of 38 knees

Cited by 9 publications

References 17 publications

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

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

Should venous doppler ultrasonography be routinely applied before lower extremity major orthopedic surgery?

Fatal pulmonary embolism subsequent to the use of Esmarch bandage and tourniquet: A case report and review of literature

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