Tourniquet use during arthroscopy did not adversely affect patient outcomes

Question: In patients having knee arthroscopy, what is the effect of tourniquet use on postoperative pain and functional outcomes?

Design: Randomized (allocation concealed), double-blind, controlled trial with 3-month follow-up.

Setting: University hospital in London, Ontario, Canada.

Patients: Patients older than 16 years of age who were scheduled for 1-hour knee arthroscopy. Exclusion criteria were anterior cruciate or posterior cruciate ligament reconstructive surgery, total synovectomy or meniscal suturing, evidence of neuromuscular disease or systemic illness, or in- ability to read or write in English. Of 145 patients enrolled, 120 (83%) (mean age, 43 years; 72% men) met the inclusion criteria and completed the study.

Intervention: All patients had a pneumatic tourniquet applied to the thigh of the operative leg and were allocated to the tourniquet being inflated to 300 mm Hg (n = 61) or not inflated (n = 59). General anesthesia was used for all operations.

Main outcome measures: Oral narcotic use and pain (measured by a 100-mm visual analog scale) for the first 5 postoperative days; self-reported health status using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); objective functional outcome measured by the 6-minute walk test, 30-second stair climb, and 1-leg standing vertical leap; iso- kinetic strength testing; and time to return to work or sport. Health status and functional outcomes were assessed at 2 and 6 weeks and at 3 months.

Results: The study had 80% power to de- tect a 25% mean difference in WOMAC pain score. Mean WOMAC scores did not differ between the groups (2 wk, P = 0.88; 6wk,P=0.93;3mo,P=0.62).Theaver- age oral narcotic use was 48.9 mg in the inflated tourniquet group and 49.1 mg in the uninflated group. The groups did not differ for assessment of postoperative pain (P = 0.24), except in patients whose surgery lasted >30 minutes (n = 51) (greater pain was reported by the inflated tourniquet group [P = 0.019]). The groups did not differ at any time point in objec- tive functional outcome measures or iso- kinetic strength testing, time to return to work (18.2 d vs. 15.4 d, P = 0.61), or return to sport (28.2 d vs. 20.9 d, P = 0.58). The surgeons, who were blinded to tourniquet status, reported improved visibility and less technical difficulty with the inflated tourniquet, but mean operative time did not differ between the groups.

Conclusion: In patients having knee arthroscopy, tourniquet use during the procedure did not affect postoperative pain or functional outcomes.

pdf Read the full text of this this article

Share on your network
Share on FacebookShare on Google+Tweet about this on TwitterShare on LinkedIn