AST Guidelines for Best Practices for Safe Use of Pneumatic Tourniquets

3 Guideline I The CST should know if the patient plan for surgery involves the use of a pneumatic tourniquet. 1. The surgeon and/or anesthesia provider make the decision if a pneumatic tourniquet (herein referred to as tourniquet) is or is not required based upon the results of the patient’s history and physical, contraindications such as existing disease condition(s) and type and length of surgical procedure. A. CSTs should not assume that a tourniquet will be used for surgical procedures on the extremities. Studies have provided evidence that the use of a tourniquet in all instances of extremity surgery may be unnecessary and the CST should confirm with the surgeon and/or anesthesia provider if a tourniquet will be used. 1) Johnson et al. (2000) conducted a prospective randomized trial in the study of knee arthroscopies and tourniquet use in 109 patients. Patients were assigned to one of two groups; one group the tourniquet was inflated and the other not inflated. The authors reported there was no significant difference between the two groups regarding analgesic requirements, complications, duration of procedure, operative view and pain scores. The authors recommended that the routine use of a tourniquet for knee arthroscopy should be discontinued. 12 2) Kirkley et al. (2000) conducted a prospective, double-blind randomized clinical trial involving 120 patients that underwent a knee arthroscopy . Sixty-one patients were assigned to the no- tourniquet inflation group and fifty-nine to the tourniquet inflation group. Patients recorded their average pain on a visual analog scale and narcotic use for five days postoperatively. The authors reported that visualization was much better in the inflated tourniquet group, but the average operative time did not differ between the two groups. However, it was reported that the no- tourniquet inflation group had a decreased level of postoperative pain. An issue associated with the study is that the surgeons could view if the tourniquet cuff was inflated or not inflated, thus causing a bias. The authors concluded that the use of a tourniquet during knee arthroscopy did not significantly affect overall patient quality of life or functional outcome postoperatively. 13 3) Tetro and Rudan blindly randomized sixty-three patients that were scheduled for total knee arthroplasty into 33 in a tourniquet group and 30 non-tourniquet. The complication rates, hospital stay, operating time, perioperative blood loss and transfusion needs were recorded. The authors reported that the difference in the total measured blood loss, intraoperative blood loss and Hemovac drainage blood loss between the two groups were not significantly different. 14 The authors concluded that the effectiveness of a pneumatic tourniquet during total knee arthroplasty is uncertain. 14