BAHATTİN TUNCALI, HAKAN BOYA, Zeynep KAYHAN, Şükrü ARAÇ

Tourniquet pressure settings based on limb occlusion pressure determination or arterial occlusion pressure estimation in total knee arthroplasty? A prospective, randomized, double blind trial

Objective: The aim of this study was to compare the limb occlusion pressure (LOP) determination andarterial occlusion pressure (AOP) estimation methods for tourniquet pressure setting in adult patientsundergoing knee arthroplasty under combined spinal-epidural anesthesia.Methods: Ninety-three patients were randomized into two groups. Pneumatic tourniquet inflationpressures were adjusted based either on LOP determination or AOP estimation in Group 1 (46 patients,38 female and 8 male; mean age: 67.71 ± 9.17) and Group 2 (47 patients, 40 female and 7 male; meanage: 70.31 ± 8.27), respectively. Initial and maximal systolic blood pressures, LOP/AOP levels, requiredtime to estimate AOP/determinate LOP and set the cuff pressure, initial and maximal tourniquetpressures and tourniquet time were recorded. The effectiveness of the tourniquet was assessed by theorthopedic surgeons using a Likert scale.Results: Initial and maximal systolic blood pressures, determined LOP, estimated AOP, duration oftourniquet and the performance of the tourniquet were not different between groups. However,the initial (182.44 ± 14.59 mm Hg vs. 200.69 ± 15.55 mm Hg) and maximal tourniquet pressures(186.91 ± 12.91 mm Hg vs. 200.69 ± 15.55 mm Hg) were significantly lower, the time required to estimateAOP and set the tourniquet cuff pressure was significantly less (23.91 ± 4.77 s vs. 178.81 ± 25.46 s)in Group II (p ¼ 0.000). No complications that could be related to the tourniquet were observed during orafter surgery.Conclusion: Tourniquet inflation pressure setting based on AOP estimation method provides a bloodlesssurgical field that is comparable to that of LOP determination method with lower pneumatic inflationpressure and less required time for cuff pressure adjustment in adult patients undergoing total kneearthroplasty under combined spinal epidural anesthesia.

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