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Warner C, Peach C, Davies R. Widening Access: Sterile Tourniquets for Surgery to the Distal Humerus. Cureus 2023; 15:e46148. [PMID: 37900452 PMCID: PMC10613037 DOI: 10.7759/cureus.46148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Purpose of the study The use of tourniquets during surgery of the distal humerus can improve visibility and reduce surgical time. However, the available operating field can be limited due to the size and placement of the tourniquet. This proof-of-concept study aimed to determine if sterile tourniquets can provide a wider surgical field compared to non-sterile tourniquets for procedures around the distal humerus. Methods Volunteers (n = 5) were positioned to simulate access to the distal humerus. The distance from the posterior corner of the acromion to the tip of the olecranon was measured. Participants were draped according to the standard protocol for the use of a non-sterile or sterile tourniquet for distal humerus and humeral shaft fractures. Two non-sterile pneumatic tourniquets (standard and narrow) and two sterile tourniquets (pneumatic and elastic exsanguination) were tested. The surgical field was measured from the sterile drape or tourniquet proximally to the tip of the olecranon. A one-way repeated measures ANOVA was conducted to examine the effect of each tourniquet on the surgical field. Results The sterile elastic exsanguination tourniquet had the largest available field with a mean of 24.4 cm (71% of arm available for incision after application), followed by the sterile pneumatic tourniquet of 20.0 cm (58%), narrow non-sterile pneumatic of 19.2 cm (55%), and standard non-sterile pneumatic of 17.0 cm (49%). Repeated measures ANOVA determined that mean surgical field length is statistically significant between tourniquet devices (F (1.729, 6.914) = 21.783, p = .001). The surgical field length was statistically significantly increased from a non-sterile standard tourniquet to a sterile elastic tourniquet (7.4 (95% CI, 2.9-11.9) cm, p = .008) but not the other two tourniquet devices tested. Conclusion The use of certain types of sterile tourniquets can provide a wider surgical field compared to non-sterile tourniquets for procedures around the distal humerus, specifically the sterile elastic exsanguination tourniquet providing a statistically significant mean gain of 7.4 cm from the non-sterile tourniquets. These findings suggest that the use of sterile tourniquets should be considered more frequently in surgery of the distal humerus, and a sterile exsanguinating tourniquet could be considered for midshaft humeral fractures, facilitating safer exposure of the radial nerve and reduced blood loss.
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Affiliation(s)
- Christian Warner
- Trauma and Orthopaedics, Manchester Shoulder and Elbow Unit, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, GBR
| | - Christopher Peach
- Trauma and Orthopaedics, Manchester Shoulder and Elbow Unit, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, GBR
| | - Ronnie Davies
- Trauma and Orthopaedics, Manchester Shoulder and Elbow Unit, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, GBR
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Bae K, Kim G, Aldosari AM, Gim Y, Kwak YH. Sterile Silicone Ring Tourniquets in Limb Surgery: A Prospective Clinical Trial in Pediatric Patients Undergoing Orthopedic Surgery. J Pers Med 2023; 13:979. [PMID: 37373968 DOI: 10.3390/jpm13060979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Sterile silicone ring tourniquets (SSRTs) reduce intraoperative bleeding and provide a wide surgical view. Moreover, they reduce the risk of contamination and are cheaper than conventional pneumatic tourniquets. Our study describes the perioperative outcomes of sterile silicone ring tourniquet placement in pediatric patients undergoing orthopedic surgery. We prospectively recruited 27 pediatric patients aged < 18 years who underwent 30 orthopedic surgeries between March and September 2021. Following complete surgical draping, all operations were initiated by placing SSRTs. We investigated the demographic and clinical characteristics of these patients, details of the tourniquet used, and intra- and postoperative outcomes of tourniquet placement. Owing to the narrowness of tourniquet bands and tourniquet placement at the proximal ends of the extremities, wide surgical fields were achieved, without limiting joint range of motion. Bleeding control was effective. Tourniquets were applied and removed rapidly and safely, regardless of limb circumference. None of the patients experienced postoperative pain, paresthesia, skin problems at the application site, surgical site infections, ischemic problems, or deep vein thrombosis. SSRTs effectively reduced intraoperative blood loss and facilitated wide operative fields in pediatric patients with various limb sizes. These tourniquets allow quick, safe, and effective orthopedic surgery for pediatric patients.
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Affiliation(s)
- Kunhyung Bae
- Department of Orthopedic Surgery, Hanyang University Hospital, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Gisu Kim
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Amaal M Aldosari
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
- Department of Orthopaedic Surgery, Al Noor Specialist Hospital, Makkah 24242, Saudi Arabia
| | - Yeonji Gim
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul 03722, Republic of Korea
| | - Yoon Hae Kwak
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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Comparison of local pain and tissue reaction between conventional pneumatic tourniquet and disposable silicone ring tourniquet during Total Knee Arthroplasty. J Clin Orthop Trauma 2020; 15:152-155. [PMID: 33717930 PMCID: PMC7919981 DOI: 10.1016/j.jcot.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/30/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022] Open
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 1-10) 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, chi-squared 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 = 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 = 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.
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Park JY, Kim SE, Lee MC, Han HS. Elastic pneumatic tourniquet cuff can reduce postoperative thigh pain after total knee arthroplasty: a prospective randomized trial. BMC Musculoskelet Disord 2020; 21:565. [PMID: 32825814 PMCID: PMC7442977 DOI: 10.1186/s12891-020-03579-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/06/2020] [Indexed: 12/03/2022] Open
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.
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Affiliation(s)
- Jae-Young Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sung Eun Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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León-Muñoz VJ, López-López M, Martínez-Martínez F, Santonja-Medina F. Impact of surgical instrumentation on hospital length of stay and cost of total knee arthroplasty. Expert Rev Pharmacoecon Outcomes Res 2020; 21:299-305. [PMID: 32564699 DOI: 10.1080/14737167.2020.1778468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND We aimed to analyze the impact of two different types of surgical instrumentation (conventional manual instrumentation (CI) and patient-specific instrumentation (PSI)) on length of stay (LOS) and objectify differences in cost. We hypothesized that there are no differences in the LOS and cost due to the instrumentation system used. RESEARCH DESIGN AND METHODS LOS was registered using inpatient admission data provided by the Institutional Management Control Department. We recorded the costs associated with each procedure that could be influenced by the use of one system or another during the in-hospital stay. We conducted a prospectively single-center cohort study of 305 TKAs. Surgery was performed with conventional CI in 122 cases and with PSI in 183 cases. RESULTS The mean LOS for the CI group was 4.29 days (SD 1.65) and 4.22 days (SD 1.26), for the PSI group. No significant difference among both instrumentation systems was obtained. When comparing global costs, the mean cost was slightly higher (without a significant difference) for the PSI cases (€3110.24 vs. €2852.7 for the CI cases). CONCLUSIONS LOS and overall cost, in hospitals with a low annual TKA surgery volume, are unrelated to conventional or patient-specific instrumentation.
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Affiliation(s)
- Vicente J León-Muñoz
- Department of Orthopedics and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Mirian López-López
- Subdirección General de Tecnologías de la Información, Servicio Murciano de Salud, Murcia, Spain
| | - Francisco Martínez-Martínez
- Department of Orthopedics and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Fernando Santonja-Medina
- Department of Orthopedics and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Faculty of Medicine, University of Murcia, Murcia, Spain
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Cai DF, Fan QH, Zhong HH, Peng S, Song H. The effects of tourniquet use on blood loss in primary total knee arthroplasty for patients with osteoarthritis: a meta-analysis. J Orthop Surg Res 2019; 14:348. [PMID: 31703706 PMCID: PMC6839231 DOI: 10.1186/s13018-019-1422-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 10/16/2019] [Indexed: 12/16/2022] Open
Abstract
Background The tourniquet is a common medical instrument used in total knee arthroplasty (TKA). However, there has always been a debate about the use of a tourniquet and there is no published meta-analysis to study the effects of a tourniquet on blood loss in primary TKA for patients with osteoarthritis. Methods We performed a literature review on high-quality clinical studies to determine the effects of using a tourniquet or not on blood loss in cemented TKA. PubMed, Web of Science, MEDLINE, Embase, and the Cochrane Library were searched up to November 2018 for relevant randomized controlled trials (RCTs). We conducted a meta-analysis following the guidelines of the Cochrane Reviewer’s Handbook. We used the Cochrane Collaboration’s tool for assessing the risk of bias of each trial. The statistical analysis was performed with Review Manager statistical software (version 5.3). Results Eleven RCTs involving 541 patients (541 knees) were included in this meta-analysis. There were 271 patients (271 knees) in the tourniquet group and 270 patients (270 knees) in the no tourniquet group. The results showed that using a tourniquet significantly decreased intraoperative blood loss (P < 0.002), calculated blood loss (P < 0.002), and the time of operation (P < 0.002), but tourniquet use did not significantly decrease postoperative blood loss (P > 0.05), total blood loss (P > 0.05), the rate of transfusion (P > 0.05), and of deep vein thrombosis (DVT) (P > 0.05) in TKA. Conclusions Using a tourniquet can significantly decrease intraoperative blood loss, calculated blood loss, and operation time but does not significantly decrease the rate of transfusion or the rate of DVT in TKA. More research is needed to determine if there are fewer complications in TKA without the use of tourniquets.
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Affiliation(s)
- D F Cai
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical College, 149 Dalian Road, Huichuan District, Zunyi City, Gui Zhou Province, China.
| | - Q H Fan
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical College, 149 Dalian Road, Huichuan District, Zunyi City, Gui Zhou Province, China
| | - H H Zhong
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical College, 149 Dalian Road, Huichuan District, Zunyi City, Gui Zhou Province, China
| | - S Peng
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical College, 149 Dalian Road, Huichuan District, Zunyi City, Gui Zhou Province, China
| | - H Song
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical College, 149 Dalian Road, Huichuan District, Zunyi City, Gui Zhou Province, China
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