Comparative analysis of pain in patients who underwent total knee replacement regarding the tourniquet pressure

Leão, Marcos George de Souza; Neta, Gladys Pedrosa Martins; Coutinho, Lucas Inoue; Silva, Thiago Montenegro da; Ferreira, Yacov Machado Costa; Dias, Waryla Raissa Vasconcelos

doi:10.1016/j.rboe.2016.09.005

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Revista Brasileira de Ortopedia

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ORIGINAL ARTICLES • Rev. bras. ortop. 51 (06) • Nov-Dec 2016 • https://doi.org/10.1016/j.rboe.2016.09.005 copy

Comparative analysis of pain in patients who underwent total knee replacement regarding the tourniquet pressure^{^☆} ☆ Study conducted at the Fundação Hospital Adriano Jorge, Departamento de Ortopedia e Traumatologia, Manaus, AM, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVES:

To evaluate through the visual analog scale (VAS) the pain in patients undergoing total knee replacement (TKR) with different pressures of the pneumatic tourniquet.

METHODS:

An observational, randomized, descriptive study on an analytical basis, with 60 patients who underwent TKR, divided into two groups, which were matched: a group where TKR was performed with tourniquet pressures of 350 mmHg (standard) and the other with systolic blood pressure plus 100 mmHg (P + 100). These patients had their pain assessed by VAS at 48 h, and at the 5th and 15th days after procedure. Secondarily, the following were also measured: range of motion (ROM), complications, and blood drainage volume in each group; the data were subjected to statistical analysis.

RESULTS:

After data analysis, there was no statistical difference regarding the incidence of complications (p = 0.612), ROM (p = 0.202), bleeding after 24 and 48 h (p = 0.432 and p = 0.254) or in relation to VAS. No correlation was observed between time of ischemia compared to VAS and bleeding.

CONCLUSIONS:

The use of the pneumatic tourniquet pressure at 350 mmHg or systolic blood pressure plus 100 mmHg did not influence the pain, blood loss, ROM, and complications. Therefore the pressures at these levels are safe and do not change the surgery outcomes; the time of ischemia must be closely observed to avoid major complications.

Keywords:
Arthroplasty, replacement, knee; Pain measurement; Tourniquets

	Tourniquet pressure (mmHg)
Variables (n= 60)	P + 100		350
	f _i	%	f _i	%	Total	p
Sex						0.766^a
Female	22	48.9	23	51.1	45
Male	8	53.3	7	46.7	15
Age (years)						0.794^b
Mean ± SD	66.0 ± 7.0		65.4 ± 8.6
Complications						0.612^c
Yes	1	3.3	3	10.0	4
No	29	96.7	27	90	56
VAS 2nd POD						0.625^d
Median	2.0		2.0
Q₁–Q₃	0.5–3.0		0.5–4.0
VAS 5th POD						0.571^d
Median	2.0		1.0
Q₁–Q₃	1.5–3.0		0.5–3.0
VAS 15th POD						0.195^d
Median	2.0		3.0
Q₁–Q₃	1.0–3.0		1.5–5.0
Bleeding 24 h						0.432^d
Median	525.0		590.0
Q₁–Q₃	380–760		450–900
Bleeding 48 h						0.254^d
Median	170.0		120.0
Q₁–Q₃	105–240		55–180

	Tourniquet pressure
Variables (n= 60)	P + 100 mmHg			350 mmHg
	Q ₁	Median	Q ₃	Q ₁	Median	Q ₃	p ^a
Flexion pre-	100.0	110.0	120.0	100.0	110.0	120.0	0.375
Flexion post-	90.0	95.0	100.0	90.0	97.5	130.0	0.664
Extension pre-	0.0	2.5	10.0	0.0	0.0	10.0	0.980
Extension post-	0.0	0.0	0.0	0.0	5.0	10.0	<0.001
ROM pre-	95.0	107.5	120.0	90.0	100.0	120.0	0.398
ROM post	90.0	95.0	100.0	80.0	90.0	100.0	0.202

	Ischemia time
Variables (n= 60)	R	p ^a
VAS 2nd POD	-0.18	0.174
VAS 5th POD	0.21	0.102
VAS 15th POD	0.13	0.318
Bleeding 24 h	-0.02	0.882
Bleeding 48 h	-0.08	0.558

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail: mgsleao@uol.com.br (M.G. de Souza Leão).

Application	Only in healthy limbs, or with caution in involved limbs.
Size of the tourniquet	Arm 10 cm; thigh 15 cm or larger in larger thighs.
Application site	Proximal arm; proximal thigh.
Padding	At least two layers of orthopedic cotton.
Skin preparation	Avoid soaking the cotton (the tourniquet should be occluded).
Pressure	50–100 mmHg above systolic for the arm; double systolic for the thigh; or 200–250 mmHg on the arm; 250–350 mmHg on the thigh.
Time (duration)	Maximum 3 h (recovers in 5–7 days); generally, do not exceed 3 h.
Temperature	Avoid heating; cold if feasible; the surgical field should be kept moist.
Documentation	Duration and pressure.
Calibration	At least weekly, with a mercury manometer.
Maintenance	Quarterly.

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Comparative analysis of pain in patients who underwent total knee replacement regarding the tourniquet pressure☆ ☆ Study conducted at the Fundação Hospital Adriano Jorge, Departamento de Ortopedia e Traumatologia, Manaus, AM, Brazil.

ABSTRACT

OBJECTIVES:

METHODS:

RESULTS:

CONCLUSIONS:

Comparative analysis of pain in patients who underwent total knee replacement regarding the tourniquet pressure^{^☆} ☆ Study conducted at the Fundação Hospital Adriano Jorge, Departamento de Ortopedia e Traumatologia, Manaus, AM, Brazil.