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2021, Number 1

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Revista Cubana de Ortopedia y Traumatología 2021; 35 (1)

Advantages and limitations of the use of tourniquet in orthopedics and traumatology

Rizo FY, Aparicio MAI, Calzado CR, Rondón GOV

Language: Spanish
References: 63
Page: 1-23
PDF size: 371.17 Kb.


ABSTRACT

Introduction: Although controversial, tourniquets are widely used in orthopedic and trauma surgery with the aim of reducing intraoperative blood losses and improving the visibility of anatomical structures.
Objective: To describe the practical applications and limitations of tourniquets in orthopedic and trauma surgery.
Method: A non-systematic review of the literature was carried out, in scientific databases such as Cochrane Database of Systematic Reviews, Pubmed / Medline, EMBASE, Scopus, Web of Science, EBSCOhost, ScienceDirect, OVID and the academic search engine Google Scholar, in the month of September 2020.
Conclusions: Although tourniquets are widely used during orthopedic and trauma surgery, since they contribute to reducing intraoperative blood loss, the effect on increasing total blood loss has been demonstrated, as well as the association with perioperative pain, blood loss, limb muscle strength, peripheral nerve injuries, deep vein thrombosis and damage to distant organs due to the ischemia-reperfusion phenomenon.


REFERENCES

  1. Canillas F, Gómez S, García JA, Pavía J, Muñoz M. ''Patient blood management'' en cirugía ortopédica. Rev Esp Cir Ortop [Internet]. 2015;59:137-49. DOI: https://doi.org/10.1016/j.recot.2014.11.005

  2. Moráis S, Ortega M, Rodríguez EC, Padilla NG, Pérez H, Figueredo R. Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach. Int Orthop [Internet]. 2014;38:347-54. DOI: https://doi.org/10.1007/s00264-013-2188-7

  3. Welling D, McKay P, Rasmussen T, Rich N. A brief history of the tourniquet. J Vasc Surg [Internet]. 2012;55:286-90. DOI: https://doi.org/10.1016/j.jvs.2011.10.085

  4. Noordin S, McEwen J, Kragh JF. Surgical tourniquets in orthopaedics J Bone Joint Surg Am [Internet]. 2009;91(12):2958-67. DOI: https://doi.org/10.2106/JBJS.I.00634

  5. Oragui E, Parsons A, White T. Tourniquet use in upper limb surgery. Hand [Internet]. 2011;6(2):165-73. DOI: https://doi.org/10.1007/s11552-010-9312-6

  6. Lakstein D, Blumenfeld A, Sokolov T. Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience. J Trauma [Internet]. 2003;54(5):221-5. DOI: https://doi.org/10.1097/01.TA.0000047227.33395.49

  7. McMillan TE, Gardner T, Johnstone AJ. Current concepts in tourniquet uses. Surgery [Internet]. 2020 March 01;38(3):139-42. DOI: https://doi.org/10.1016/j.mpsur.2020.01.005

  8. Touzopoulos P, Ververidis A, Mpogiatzis C, Chatzigiannakis A, Drosos GI. The use of tourniquet may influence the cement mantle thickness under the tibial implant during total knee arthroplasty. Eur J Orthop Surg Traumatol [Internet]. 2019;29(4):869-75. DOI: https://doi.org/10.1007/s00590-019-02369-8

  9. Zhao HY, Yeersheng R, Kang XW, Xia YY, Kang PD, Wang WJ, et al. The effect of tourniquet uses on total blood loss, early function, and pain after primary total knee arthroplasty. Bone Joint Res [Internet]. 2020;9(6):322-32. DOI: https://doi.org/10.1302/2046-3758.96.BJR-2019-0180.R3

  10. Dennis DA, Kittelson AJ, Yang C. Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial. Clin Orthop Relat Res [Internet]. 2016;474(1):69-77. DOI: https://doi.org/10.1007/s11999-015-4393-8

  11. Tsubosaka M, Ishida K, Sasaki H. Effects of Suture and Tourniquet on Intraoperative Kinematics in Navigated Total Knee Arthroplasty. J Arthroplasty [Internet]. 2017;32(6):1824-8. DOI: https://doi.org/10.1016/B978-0-12-394309-5.00006-7

  12. Zhou K, Ling T, Wang H, Zhou Z, Shen B, Yang J, et al. Influence of tourniquet use in primary total knee arthroplasty with drainage: a prospective randomised controlled trial. Journal of Orthopaedic Surgery and Research [Internet]. 2017;12:172. DOI: https://doi.org/10.1186/s13018-017-0683-z

  13. Muyskens JB, Hocker AD, Turnbull DW, Shah SN, Lantz BA, Jewett BA, et al. Transcriptional profiling and muscle cross-section analysis reveal signs of ischemia reperfusion injury following total knee arthroplasty with tourniquet. Physiol Rep [Internet]. 2016;4(1):e12671. DOI: https://doi.org/10.14814/phy2.12671

  14. Wong S, Irwin MG. Procedures under tourniquet. Anaesthesia and intensive care medicine [Internet]. 2018 April 01;19(4):155-8. DOI: https://doi.org/10.1016/j.mpaic.2018.01.007

  15. Arthur JR, Spangehl MJ. Tourniquet Use in Total Knee Arthroplasty. J Knee Surg [Internet]. 2019;32:719-29. DOI: https://doi.org/10.1055/s-0039-1681035

  16. Kalogeris T, Baines CP, Krenz M, Korthuis RJ. Cell biology of ischemia/reperfusion injury. Int Rev Cell Mol Biol [Internet]. 2012;298:229-317. DOI: https://doi.org/10.1002/cphy.c160006

  17. Kalogeris T, Baines CP, Krenz M, Korthuis RJ. Ischemia/reperfusion. Compr Physiol [Internet]. 2016;7:113-70. DOI: https://doi.org/10.3390/jcm8020267

  18. Leurcharusmee P, Sawaddiruk P, Punjasawadwong Y, Chattipakorn N, Chattipakorn SC. The Possible Pathophysiological Outcomes and Mechanisms of Tourniquet-Induced Ischemia-Reperfusion Injury during Total Knee Arthroplasty. Oxidative Medicine and Cellular Longevity [Internet]. 2018 Nov 5; ID: 8087598. DOI: https://doi.org/10.1155/2018/8087598

  19. Chen L, Zhao H, Alam A. Postoperative remote lung injury and its impact on surgical outcome. BMC Anesthesiology [Internet]. 2019;19(1):1-10. DOI: https://doi.org/10.1186/s12871-019-0698-6

  20. Abassi Z, Armaly Z, Heymanx SN. Glycocalyx Degradation in Ischemia-Reperfusion Injury. The American Journal of Pathology [Internet]. 2020;190(4):752-67. DOI: https://doi.org/10.1016/j.ajpath.2019.08.019

  21. Abassi Z, Rosen S, Lamothe S, Heyman SN. Why have detection, understanding and management of kidney hypoxic injury lagged behind those for the heart? J Clin Med [Internet]. 2019;8:267. DOI: https://dx.doi.org/10.1055%2Fs-0036-1571281

  22. Bogdan Y, Helfet DL. Use of Tourniquets in Limb Trauma Surgery. Orthop Clin N Am [Internet]. 2018;49(2):157-65. DOI: https://doi.org/10.1016/j.ocl.2017.11.004

  23. Jalón MS, López MAB, Cobo CMS, Bartolomé ER, Fernández MS, Cobo GC, et al. Assessment of the Pneumatic Ischemia Technique Using the Limb Occlusion Pressure During Upper Limb Surgery. Journal of Peri Anesthesia Nursing [Internet]. 2018 Oct;33(5):699. DOI: http://dx.doi.org/10.1016/j.jopan.2016.08.017

  24. Stimpson J, Gill DF, Memarzadeh A, Dunne M, Perry L, Magan A, et al. Reducing the Hypertensive Effects of the Prolonged Surgical Tourniquet Using a Dual-Cuff Strategy: A Prospective Randomized Controlled Trial. The Journal of Foot & Ankle Surgery [Internet]. 2019;58:1177-86. DOI: https://doi.org/10.1053/j.jfas.2019.03.019

  25. Sarfani S, Cantwell S, Shin AY, Kakar S. Challenging the dogma of tourniquet pressure requirements for upper extremity surgery. J Wrist Surg [Internet]. 2016;5:120-3. DOI: https://doi.org/10.1007%2Fs11552-014-9667-1

  26. AORN. Recommended practices for the use of the pneumatic tourniquet in the perioperative practice setting. AORN J. 2007 Oct;86(4):640-55. DOI: https://doi.org/10.1016/j.aorn.2007.09.004

  27. Drolet BC, Okhah Z, Phillips BZ. Evidence for safe tourniquet use in 500 consecutive upper extremity procedures. Hand [Internet]. 2014;9:494-8. DOI: https://doi.org/10.5435/JAAOS-20-05-310

  28. Pyati S, Cobert J, Jabre JF, Kaye AD, Diaz JH, Raghunathan K. Effects of Tourniquets in the Development of Pain States: a Novel Clinical Pilot Study and Review of Utilization of Tissue Oximetry to Measure Neural Ischemia. Current Pain and Headache Reports [Internet]. 2020;24:25. DOI: https://doi.org/10.1007/s11916-020-00855-x

  29. Patel NK, Johns W, Vedi V, Langstaff RJ, Golladay GJ. Tourniquet and tranexamic acid use in total knee arthroplasty. Arthroplasty Today [Internet]. 2020;6(2):246-50. DOI: https://doi.org/10.1016/j.artd.2020.02.007

  30. Fitzgibbons PG, Digiovanni C, Hares S. Safe tourniquet use: a review of the evidence. J Am Acad Orthop Surg [Internet]. 2012;20(5):310-9. DOI: https://doi.org/10.5435/JAAOS-20-05-310

  31. Benedick A, Rivera T, Vallier HA. Effect of Tourniquet Use During Ankle Fracture Fixation on Wound Healing and Infectious Complications. Foot & Ankle International [Internet]. 2020 Jun;41(6):714-20. DOI: https://doi.org/10.1177/107110072090737

  32. Zhang Y, Li D, Liu P, Wang X, Li M. Effects of different methods of using pneumatic tourniquet in patients undergoing total knee arthroplasty: a randomized control trial. Ir J Med Sci [Internet]. 2017;186:953-9. DOI: https://doi.org/10.1007/s11845-017-1585-0

  33. Mori N, Kimura S, Onodera T, Iwasaki N, Nakagawa I, Masuda T. Use of a pneumatic tourniquet in total knee arthroplasty increases the risk of distal deep vein thrombosis: A prospective, randomized study. Knee [Internet]. 2016;23:887-9. DOI: https://doi.org/10.1016/S0363-5023(79)80008-8

  34. Maldonado F, Morales D, Gutiérrez R, Barahona M, Cerda O, Cáceres M. Effect of sevoflurane and propofol on tourniquet-induced endothelial damage: a pilot randomized controlled trial for knee ligament surgery. BMC Anesthesiology [Internet]. 2020;20:121. DOI: https://doi.org/10.1186/s12871-020-01030-w

  35. Kim TK, Bamne AB, Sim JA, Park JH, Na YG. Is lower tourniquet pressure during total knee arthroplasty effective? A prospective randomized controlled trial. BMC Musculoskeletal Disorders [Internet]. 2019;20:275. DOI: https://doi.org/10.1186/s12891-019-2636-7

  36. Besir A, Tugcugil E. Does Tourniquet Time or Pressure Contribute to Intracranial Pressure Increase following Tourniquet Application? Med Princ Pract [Internet]. 2019;18:16-22. DOI: https://doi.org/10.1159/000495110

  37. Huwae TECJ, Santoso ARB, Kesuma W, Sujuti H, Ratnawati R, Sukmajaya WP, et al. Reperfusion Interval as a Prevention of Lung Injury Due to Limb Ischemia-Reperfusion After Application of Tourniquet in Murine Experimental Study. Indian Journal of Orthopaedics [Internet]. 2020;54:704-10. DOI: https://doi.org/10.1007/s43465-020-00100-y

  38. Mangum LC, Garcia GR, Akers KS, Wenke JC. Duration of extremity tourniquet application profoundly impacts soft-tissue antibiotic exposure in a rat model of ischemia-reperfusion injury. Injury [Internet]. 2019;50(12):2203-14 DOI: https://doi.org/10.1016/j.injury.2019.09.025

  39. Cao Q, He Z, Fan Y, Meng J, Yuan T, Zhao J, et al. Effects of tourniquet application on enhanced recovery after surgery (ERAS) and ischemia-reperfusion posttotal knee arthroplasty: Full- versus second half-course application. Journal of Orthopaedic Surgery [Internet]. 2020;28(1):1-8. DOI: https://doi.org/10.1177/2309499019896026

  40. Miller SH, Price G, Buck D. Effects of tourniquet ischemia and postischemic edema on muscle metabolism. J Hand Surg Am [Internet]. 1979;4(6):547-55. DOI: https://doi.org/10.1016/j.jss.2012.06.033

  41. Maldonado C, Pushpakumar SB, Abadia GP, Arumugam S, Lane AN. Administration of exogenous adenosine triphosphate to ischemic skeletal muscle induces an energy-sparing effect: role of adenosine receptors. J Surg Res [Internet]. 2013;181(1):[15-22]. DOI: https://doi.org/10.1080/08941930390215015

  42. Kabaroudis A, Gerassimidis T, Karamanos D, Papaziogas B, Antonopoulos V, Sakanamis A. Metabolic alterations of skeletal muscle tissue after prolonged acute ischemia and reperfusion. J Invest Surg [Internet]. 2003;16(4):219-28. DOI: https://doi.org/10.1097/00000542-200012000-00011

  43. Korth U, Merkel G, Fernandez FF. Tourniquet-induced changes of energy metabolism in human skeletal muscle monitored by microdialysis. Anesthesiology [Internet]. 2000;93(6):1407-12. DOI: https://dx.doi.org/10.1097%2FMD.0000000000006786

  44. Dreyer HC. Tourniquet Use During Knee Replacement Surgery May Contribute to Muscle Atrophy in Older Adults. Exerc Sport Sci Rev [Internet]. 2016;44(2):61-70. DOI: https://doi.org/10.1249/JES.0000000000000076

  45. Tai TW, Lin CJ, Jou IM, Chang CW, Lai KA, Yang CY. Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc [Internet]. 2011;19(7):1121-30. DOI: http://dx.doi.org/10.1007/s00167-010-1342-7

  46. Zhang P, Liang Y, He J, Fang Y, Chen P, Wang J. Timing of tourniquet release in total knee arthroplasty - a meta-analysis. Medicine [Internet]. 2017;96:17. DOI: https://doi.org/10.1055/s-0039-1688565

  47. Bressi E, Longo UG, Mangiacapra F. Impact of Tourniquet Use on Systemic Inflammatory Parameters, Functional Physical Recovery, and Cardiovascular Outcomes of Patients Undergoing Knee Arthroplasty: A case-control study. J Knee Surg [Internet]. 2019;24: 2595-605. DOI: https://doi.org/10.1007/s00167-015-3872-5

  48. Guler O, Mahirogullari M, Isyar M, Piskin A, Yalcin S, Mutlu S. Comparison of quadriceps muscle volume after unilateral total knee arthroplasty with and without tourniquet use. Knee Surg Sports Traumatol Arthrosc [Internet]. 2016;24(8):2595-605. DOI: https://doi.org/10.2106/JBJS.16.00750

  49. Kumar K, Railton C, Tawfic Q. Tourniquet application during anesthesia: "What we need to know?". Journal of Anaesthesiology Clinical Pharmacology [Internet]. 2016;32(4):424-30. DOI: https://doi.org/10.4103/0970-9185.168174

  50. Yin D, Delisle J, Banica A, Senay A, Ranger P, Laflamme GY, et al. Tourniquet and closed-suction drains in total knee arthroplasty. No beneficial effects on bleeding management and knee function at a higher cost. Orthopaedics & Traumatology: Surgery & Research [Internet]. 2017;103:583-9. DOI: http://dx.doi.org/10.1016/j.otsr.2017.03.002

  51. Gunasagaran J, Sean ES, Shivdas S, Amir S, Ahmad TS. Perceived comfort during minor hand surgeries with wide awake local anaesthesia no tourniquet (WALANT) versus local anaesthesia (LA)/tourniquet. Journal of Orthopaedic Surgery [Internet]. 2017;25(3):1-4. DOI: https://doi.org/10.1177/2309499017739499

  52. Schnettler T, Papillon N, Rees H. Use of a Tourniquet in Total Knee Arthroplasty Causes a Paradoxical Increase in Total Blood Loss. J Bone Joint Surg Am [Internet]. 2017;99-A(16):1331-6. DOI: https://doi.org/10.1007/s00167-015-3582-z

  53. Tie K, Hu D, Qi Y, Wang H, Chen L. Effects of Tourniquet Release on Total Knee Arthroplasty. Orthopedics [Internet]. 2016;39(4):e642-e50. DOI: https://doi.org/10.3928/01477447-20160606-03

  54. Wang J, Xu W, Lv J. Is It Better to Routinely Use Tourniquet for Knee Arthroscopic Surgery: A Systematic Review and Meta-analysis. J Knee Surg. 2020;33(9):866-74. DOI: https://doi.org/10.1055/s-0039-1688555

  55. Reda W, ElGuindy AMF, Zahry G, Faggal MS, Karim MA. Anterior cruciate ligament reconstruction; is a tourniquet necessary? A randomized controlled trial. Knee Surg Sports Traumatol Arthrosc [Internet]. 2016;24(9):2948-52. DOI: https://doi.org/10.1007/s00167-014-3341-6

  56. Pfitzner T, Roth Pv, Voerkelius N, Mayr H, Perka C, Hube R. Influence of the tourniquet on tibial cement mantle thickness in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc [Internet]. 2016;24:96. DOI: https://doi.org/10.1097/TA.0000000000001826

  57. Kauvar DS, Dubick MA, Walters TJ, Kragh JF. Systematic review of prehospital tourniquet use in civilian limb trauma. J Trauma Acute Care Surg [Internet]. 2018;84:819-25. DOI: https://doi.org/10.1007/s00776-014-0664-6

  58. Alexandersson M, Wang EY, Eriksson S. A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study. Knee Surgery, Sports Traumatology, Arthroscopy [Internet]. 2019;27:1035-42. DOI: https://doi.org/10.1007/s00167-018-5196-8

  59. Jiang FZ, Zhong HM, Hong YC, Zhao GF. Use of a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Orthop Sci [Internet]. 2015;20:110. DOI: http://refhub.elsevier.com/S2352-3441(20)30020-0/sref18

  60. Zarrouki Y, Abouelhassan T, Samkaoui MA. Cardiac arrest after tourniquet deflation in upper limb. Trauma Case Reports [Internet]. 2017;7:1-2. DOI: http://dx.doi.org/10.1016/j.tcr.2017.01.001

  61. Meybohm P, Bein B, Brosteanu O, Cremer J, Gruenewald M, Stoppe C, et al. A Multicenter Trial of Remote Ischemic Preconditioning for Heart Surgery. N Engl J Med [Internet]. 2015;373(15):1397-407. DOI: https://doi.org/10.1056/NEJMoa1413579

  62. Huang ZY, Xie XW, Li L, Huang Q, Ma J, Shen B, et al. Intravenous and Topical Tranexamic Acid Alone Are Superior to Tourniquet Use for Primary Total Knee Arthroplasty. J Bone Joint Surg Am [Internet]. 2017;99-A(24):2053-61. DOI: http://dx.doi.org/10.2106/JBJS.16.01525

  63. Que Y, Xue J. Propofol activates autophagic activity of vascular endothelial cells by inhibiting SENP1 expression and attenuates vascular endothelial injury induced by ischemia-reperfusion in orthopedic surgery. Biotechnology & Biotechnological Equipment [Internet]. 2019;33(1):1572-81. DOI: https://doi.org/10.1080/13102818.2019.1673208




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