Elastic pneumatic tourniquet cuff can reduce postoperative thigh pain after total knee arthroplasty: a prospective rando
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RESEARCH ARTICLE
Open Access
Elastic pneumatic tourniquet cuff can reduce postoperative thigh pain after total knee arthroplasty: a prospective randomized trial Jae-Young Park, Sung Eun Kim, Myung Chul Lee and Hyuk-Soo Han*
Abstract Background: Tourniquet use is associated with complications such as thigh pain, skin problems, and deep vein thrombosis (DVT). This prospective study aimed to evaluate the efficacy and safety of the pneumatic tourniquet system using an elastic cuff and limb occlusion pressure (LOP) in total knee arthroplasty (TKA). The hypothesis of this study was that an elastic cuff tourniquet would result in less postoperative thigh pain after TKA. Methods: This prospective randomized controlled trial involved a total of 98 patients who underwent primary TKA. They were randomized into two groups: tourniquet system using an elastic cuff and LOP group (Group E) and tourniquet system using a conventional-cuff and LOP group (Group C). Outcomes including postoperative thigh pain assessed using a visual analog scale (VAS), serum muscle enzymes, recommended tourniquet pressure (RTP), bloodlessness of surgical field, surgical time, incidence of DVT, and the frequency of rescue analgesic use after surgery, were compared between groups. Results: Patients in Group E experienced significantly less thigh pain compared to those in Group C on postoperative day 4 (P = 0.01) and day 7 (P = 0.04). The difference between RTP and systolic blood pressure was significantly lower in Group E (P = 0.045). One case of thigh DVT was found in Group E, while no such cases were found in Group C. One and two cases of poor bloodless surgical fields were observed in Group E and Group C, respectively. There was no significant difference in surgical time, levels of serum muscle enzymes, and the frequency of rescue analgesic use between the two groups. Conclusions: The pneumatic tourniquet system using an elastic cuff and LOP reduced early postoperative thigh pain more effectively than did the tourniquet system using a conventional cuff and LOP. Trial registration: #KCT0003149. Registered August 17, 2018 - Retrospectively registered. Keywords: Total knee arthroplasty, Automatic pneumatic tourniquet, Elastic cuff
Background In many orthopedic surgeries, the pneumatic tourniquet is efficiently used to achieve a bloodless surgical field. It decreases total blood loss during surgery, facilitates * Correspondence: [email protected] Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
cementation, and decreases operative time [1–3], especially in total knee arthroplasties (TKAs). The conventional tourniquet pressure in TKAs is approximately 300–350 mmHg. High pressure may lead to postoperative complications such as ischemic pain, swelling, skin abrasions, blisters, rhabdomyolysis, deep vein thrombosis (DVT), wound healing disorders, and nerve palsy [4–8].
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4
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