AST Guidelines for Best Practices for Safe Use of Pneumatic Tourniquets

4 4) Researchers conducted a randomized controlled trial involving 100 patients undergoing a total knee arthroplasty. The study was conducted to determine if epinephrine-augmented hypotensive epidural anesthesia could be used in place of a tourniquet without effecting hemoglobin values. Group A consisted of forty-nine patients who received epinephrine-augmented hypotensive epidural anesthesia and Group B that received normotensive epidural anesthesia with a tourniquet. The researchers evaluated hemoglobin values preoperatively, intraoperatively and six hours postoperatively, as well as postoperative days one through three, five and six. The researchers reported epinephrine-augmented hypotensive epidural anesthesia is an effective method to avoid tourniquet use during total knee arthroplasty without negative effects on perioperative hemoglobin values. 15 5) Smith and Hing completed a meta-analysis and systematic review of the databases Medline, CINAHL, AMED and EMBASE as well as a personal search of orthopedic journals; the articles were assessed using the Cochrane Bone, Joint and Muscle Trauma Group. The authors compared the outcomes of tourniquet-assisted to non-tourniquet assisted total knee arthroplasty. Fifteen studies were identified involving 1,040 procedures in 991 patients. The researchers reported there was no significant difference between the two groups for total blood loss or transfusion rate. However, they identified there were more complications in the patients with tourniquet. 16 The researchers concluded that there is no advantage to using a tourniquet in total knee arthroplasty to reduce transfusion requirements. 16 6) A prospective, double-blind randomized clinical trial was conducted to evaluate whether tourniquet use effects the duration of surgery, recovery of movement and joint volume in patients who underwent a knee arthroscopy with partial meniscectomy using an arthropump with pressure sensor. 103 patients were divided into Group 1 consisting of fifty-one patients without an inflated tourniquet and Group 2 consisting of fifty-two patients with inflated tourniquet. The researchers reported there was no statistically significant differences among any of the variables and therefore, concluded that there are no reasons for justifying or discrediting tourniquet use as long as the arthropump with sensor is used. 17 7) A meta-analysis was completed to examine whether using a tourniquet during total knee arthroplasty was effective but did not increase the risk of complications. Eight randomized trials and three high-quality prospective studies involving 634 total knee arthroplasties with and without the use of a tourniquet were included in the meta-analysis. The researchers reported that the results of the analysis revealed that using a tourniquet provided