A Practical Approach for Ischemic Preconditioning Intervention in Sports: A Pilot Study for Cuff Thigh Occlusion Pressure Estimation Based on Systolic Blood Pressure.

For the ischemic preconditioning (IPC) intervention, the accuracy of the protocol is paramount for mediating its possible ergogenic effects. However, the lack of standardization and widespread use of arbitrary cuff pressures (ranging from 130 to >300 mmHg) have been predominantly observed, potentially affecting the results and compromising the reproducibility of findings. Thus, the purpose of this study was to determine an appropriate cuff pressure during IPC. Seventeen healthy male participants were enrolled in the study. Anthropometric measurements were initially conducted, followed by systolic and diastolic blood pressure measurements. Subsequently, we determined the individual thigh occlusion pressure (TOP) for the right leg using a hand-held Doppler device. Based on these findings, we developed an estimation equation for TOP, considering the current brachial systolic blood pressure (SBP) values. We then conducted a retrospective analysis of its capacity to mediate occlusion. We observed the ability to estimate TOP using the equation (p = 0.01; ES: 0.86), presenting ~6% superiority in absolute values for occlusion compared to direct measurement (TOP equation: 169.9 ± 9.1; TOP direct measured: 161.2 ± 11.1). However, TOP estimation was insufficient to produce complete occlusion in two out of 17 subjects (11.8%). In conclusion, the estimation of TOP incorporating SBP values may offer a valid and practical means for cuff administration during IPC protocols with potential to minimize adverse effects and maximize its positive effects.

Can We Forgo the Use of Tourniquets in Total Knee Arthroplasty?

Objective To analyze whether there is more bleeding in patients undergoing total knee arthroplasty (TKA) without using a tourniquet. The secondary objectives were to analyze the operative time, the length of hospital stay, the need for transfusion, and the complication rate. Methods The present is a retrospective study through the analysis of medical records. The patients were divided into two groups: TKA with and without the use of a tourniquet. Reductions in the levels of hemoglobin and packed cell volume 24 h and 48 h after surgery, the operative time, the length of hospital stay, the need for transfusion, and the rate of complications up to 6 months postoperatively were compared between the groups. Results During the period analyzed, 104 patients underwent TKA, and 94 were included in the study. There were no differences between the groups regarding the mean values of hemoglobin and packed cell volume before surgery ( p = 0.675 and p = 0.265), 24 h ( p = 0.099 and p = 0.563), and 48 h ( p = 0.569 and p = 0.810) after the procedure. Neither were there differences between the groups in terms of the operative time and the length of hospital stay ( p = 0.484 and p > 0.05). Moreover, there were no differences regarding the need for transfusion and the complication rate. Conclusion It is possible to forgo the use a tourniquet in TKA without a significant change in hemoglobin and packed cell volume levels 24 h and 48 h after surgery when compared with the group using a tourniquet. There were no significant differences in the total operative time, length of stay, need for transfusion, and complication rate.

A low-cost, DIY tourniquet simulator with built-in self-assessment for prehospital providers in Guatemala city.

BACKGROUND: Hemorrhage is the leading cause of preventable death after trauma. In high-income countries first responders are trained in hemorrhage control techniques but this is not the case for developing countries like Guatemala. We present a low-cost training model for tourniquet application using a combination of virtual and physical components. METHODS: The training program includes a mobile application with didactic materials, videos and a gamified virtual reality environment for learning. Additionally, a physical training model of a bleeding lower extremity is developed allowing learners to practice tourniquet application using inexpensive and accessible materials. Validation of the simulator occurred through content and construct validation. Content validation involved subjective assessments by novices and experts, construct validation compared pre-training novices with experts. Training validation compared pre and post training novices for improvement. RESULTS: Our findings indicate that users found the simulator useful, realistic, and satisfactory. We found significant differences in tourniquet application skills between pre-training novices and experts. When comparing pre- and post-training novices, we found a significantly lower bleeding control time between the groups. CONCLUSION: This study suggests that this training approach can enhance access to life-saving skills for prehospital personnel. The inclusion of self-assessment components enables self-regulated learning and reduces the need for continuous instructor presence. Future improvements involve refining the tourniquet model, validating it with first-responder end users, and expanding the training program to include other skills.

The optimized tourniquet versus no tourniquet in total knee arthroplasty. Analysis of muscle injury, functional recovery, and knee strength.

Background: Tourniquet is widely used in total knee replacement surgery because it reduces intraoperative hemorrhage and provides a comfortable surgical area for the surgeon. It's possible that its use could lead to impaired postoperative functional and motor recovery, as well as local and systemic complications. Our goal was to compare the outcomes of total knee replacement without ischemia using an optimized protocol, consisting of tourniquet inflation before skin incision and deflation after cementing, with a pressure of one hundred millimeters above systolic blood pressure and without postoperative articular suction drains.). We believed that tourniquet effectively would result in no additional muscle damage and no functional or knee strength impairment compared to no tourniquet. Methods: In a prospective and randomized study, 60 patients with osteoarthritis were evaluated for total knee replacement, divided in two groups: 'without tourniquet' and 'optimized tourniquet'. Outcomes were mean creatine phosphokinase levels, Knee Society Score and knee isokinetic strength. Data were considered significant when p < 0.05. Results: Creatine phosphokinase levels and functional score were similar between groups. There were no differences between groups regarding knee extension strength on the operated limbs, although the knee flexors' peak torque in the operated limb in the optimized tourniquet group was significantly higher at 6 months relative to preoperative and 3 months assessments. Conclusions: The optimized tourniquet protocol use in total knee replacement combines the benefits of tourniquet use without compromising functional recovery and without additional muscle damage and strength deficits compared to surgery without its use.

Can We Forgo the Use of Tourniquets in Total Knee Arthroplasty? / Podemos dispensar o uso do torniquete nas artroplastias totais do joelho?

Abstract Objective To analyze whether there is more bleeding in patients undergoing total knee arthroplasty (TKA) without using a tourniquet. The secondary objectives were to analyze the operative time, the length of hospital stay, the need for transfusion, and the complication rate. Methods The present is a retrospective study through the analysis of medical records. The patients were divided into two groups: TKA with and without the use of a tourniquet. Reductions in the levels of hemoglobin and packed cell volume 24 h and 48 h after surgery, the operative time, the length of hospital stay, the need for transfusion, and the rate of complications up to 6 months postoperatively were compared between the groups. Results During the period analyzed, 104 patients underwent TKA, and 94 were included in the study. There were no differences between the groups regarding the mean values of hemoglobin and packed cell volume before surgery (p = 0.675 and p = 0.265), 24 h (p = 0.099 and p = 0.563), and 48 h (p = 0.569 and p = 0.810) after the procedure. Neither were there differences between the groups in terms of the operative time and the length of hospital stay (p = 0.484 and p > 0.05). Moreover, there were no differences regarding the need for transfusion and the complication rate. Conclusion It is possible to forgo the use a tourniquet in TKA without a significant change in hemoglobin and packed cell volume levels 24 h and 48 h after surgery when compared with the group using a tourniquet. There were no significant differences in the total operative time, length of stay, need for transfusion, and complication rate.

Resumo Objetivo Analisar se há mais sangramento em pacientes submetidos a artroplastia total do joelho (ATJ) sem a utilização do torniquete. Os objetivos secundários foram analisar os tempos cirúrgico e de internação, a necessidade de transfusão e a taxa de complicações. Métodos Estudo retrospectivo por meio da análise de prontuários. Os pacientes foram divididos em dois grupos: ATJ com e sem a utilização de torniquete. Foram comparados os valores das quedas da hemoglobina e do hematócrito 24 h e 48 h após a cirurgia, os tempos cirúrgico e de internação, a necessidade de transfusão e a taxa de complicações até 5 meses de pós-operatório. Resultados No período, foram operados 104 pacientes, sendo 94 incluídos no estudo. Não houve diferença entre as médias dos valores da hemoglobina e do hematócrito entre os grupos no pré-operatório (p = 0,675 e p = 0,265, respectivamente), 24 h (p = 0,099 e p = 0,563, respectivamente) e 48 h (p = 0,569 e p = 0,810, respectivamente) após a cirurgia. O tempo cirúrgico e o tempo de internação também não foram diferentes entre os grupos (p = 0,484 e p > 0,05, respectivamente). Não houve diferença com relação à necessidade de transfusões, nem com relação à taxa de complicações analisadas. Conclusão Podemos dispensar o uso do torniquete nas cirurgias de ATJ sem alteração significativa no valor dos níveis de hemoglobina e de hematócrito 24 h e 48 h após a cirurgia quando comparado ao grupo com uso de torniquete. Não houve diferenças significativas no tempo total das cirurgias, no tempo de internação, na necessidade de transfusões e nas taxas de complicações analisadas.

Intravenous Use of Tranexamic Acid in Total Knee Arthroplasty with no Tourniquet.

Objective: To identify blood transfusion requirements and postoperative complications in patients undergoing total knee arthroplasty (TKA) with no tourniquet and intraoperative intravenous administration of tranexamic acid. Methods: This retrospective observational study analyzed 49 preopeative and postoperative medical records of patients undergoing TKA. A paired t-test compared changes in hemoglobin (HB) and packed cell volume (PCV), and an independent t-test with Welch correction compared HB and PCV changes between genders. A Spearman correlation test determined associations between age and days of postoperative hospitalization with HB and PCV changes. The significance level adopted was p < 0.05. Results: The patients' mean age was 71.9 ± 6.7 years; most subjects were women (73.5%). The right side (59.2%) was the most affected. Only one participant required a blood transfusion, while three subjects had complications during the postoperative follow-up. No patient had a thromboembolic event. The median length of postoperative hospital stay was 2 days (interquartile range [IQR] = 1.0). There were reductions in HB and PCV levels between the pre-operative and postoperative period, and female patients had a higher HB reduction. Conclusion: TKA with tranexamic acid and no tourniquet did not cause significant postoperative complications or require blood transfusions.

Middle finger tenolysis using WALANT surgical technique in a pediatric patient: A case report.

INTRODUCTION AND IMPORTANCE: Wide Awake Local Anesthesia No Tourniquet (WALANT) is a surgical technique used in hand surgery that allows for active patient participation during surgery while avoiding the pain and discomfort associated with general anesthesia and tourniquets. Using this technique for tenolysis enables a surgeon to assess the repair intraoperatively. However, this technique is more commonly used in adults than in pediatric patients. We aimed to present a case that may contribute to the use of the WALANT technique on the pediatric population. CASE PRESENTATION: This case presents the successful use of the WALANT technique multiple times in a 7-year-old Hispanic male patient to repair recurrent tendon adhesions and joint contracture due to a prior gunshot wound that caused a comminuted, displaced fracture with intra-articular extension of the third finger. CLINICAL DISCUSSION: To the best of our knowledge, few reports and case series of WALANT hand surgery in children are available within the literature. The presented case is rare in terms of the mechanism of injury, the age of the patient, and the fact that multiple WALANT interventions were successfully performed on the same patient. CONCLUSION: Our findings showcase the potential of the WALANT technique on pediatric patients as an alternative to traditional techniques. Due to the scarcity of pediatric WALANT cases in the literature, and the benefits provided by the technique, this case report may be of clinical relevance.

Intravenous Use of Tranexamic Acid in Total Knee Arthroplasty with no Tourniquet / O uso endovenoso de ácido tranexâmico na artroplastia total de joelho sem uso de torniquete

Abstract Objective: To identify blood transfusion requirements and postoperative complications in patients undergoing total knee arthroplasty (TKA) with no tourniquet and intraoperative intravenous administration of tranexamic acid. Methods: This retrospective observational study analyzed 49 preopeative and postoperative medical records of patients undergoing TKA. A paired t-test compared changes in hemoglobin (HB) and packed cell volume (PCV), and an independent t-test with Welch correction compared HB and PCV changes between genders. A Spearman correlation test determined associations between age and days of postoperative hospitalization with HB and PCV changes. The significance level adopted was p < 0.05. Results: The patients' mean age was 71.9 ± 6.7 years; most subjects were women (73.5%). The right side (59.2%) was the most affected. Only one participant required a blood transfusion, while three subjects had complications during the postoperative follow-up. No patient had a thromboembolic event. The median length of postoperative hospital stay was 2 days (interquartile range [IQR] = 1.0). There were reductions in HB and PCV levels between the pre-operative and postoperative period, and female patients had a higher HB reduction. Conclusion: TKA with tranexamic acid and no tourniquet did not cause significant postoperative complications or require blood transfusions.

Resumo Objetivo: Identificar a necessidade de transfusão sanguínea e intercorrências inerentes ao pós-operatório de pacientes submetidos à artroplastia total de joelho (ATJ), a partir de manejos realizados sem o uso de torniquete e com administração de ácido tranexâmico endovenoso intra-operatório. Métodos: Trata-se de um estudo observacional retrospectivo, a partir da observação de 49 prontuários médicos de pacientes submetidos à ATJ em pré e pós-operatório. Foi utilizado o teste t pareado para fazer comparações das modificações de hemoglobina (HB) e hematócrito (HT) e o teste t independente com correção de Welch para comparar as modificações de HB e HT entre os sexos. As associações de idade e dias de internação no pós-operatório com as modificações de HB e HT foram testadas pela correlação de Spearman. O nível de significância adotado foi p < 0,05. Resultados: Os pacientes apresentaram idade média de 71,9 ± 6,7 anos. A maioria da amostra foi composta por mulheres (73,5%) e o lado direito (59,2%) foi o mais acometido. Apenas um participante necessitou de transfusão de sangue e três participantes apresentaram intercorrências durante o seguimento pós-operatório. Nenhum paciente apresentou evento tromboembólico. A mediana da duração da internação no pós-operatório foi de dois dias (IIQ= 1,0). Verificaram-se reduções nas dosagens de HB e HT entre o pré e pós-operatório, e pacientes do sexo feminino apresentaram maior redução de HB. Conclusão: ATJ com uso de ácido tranexâmico e sem uso de torniquete não acarretou complicações pós-operatórias ou necessidade de transfusão sanguínea significativas.

WALANT Technique versus Local Anesthesia with a Tourniquet in Carpal Tunnel Syndrome.

Objectives: Obtaining a blood-free surgical field is critical during carpal tunnel decompression (CTD) to identify anatomic structures and avoid iatrogenic injury. A tourniquet is often used to minimize bleeding and improve visualization. However, it may be associated with discomfort and intolerance when sedation is not employed. WALANT ("Wide awake local anesthesia no tourniquet") technique surgeries have become very popular and enable the patient to be involved in the procedure; in addition, the adrenaline avoids the use of the tourniquet and the discomfort it produces. We hypothesized that there is no difference in postoperative pain after CTD between local anesthetic with a tourniquet (LA-T) and WALANT technique. The objective of this paper is to report the results of CTD, comparing those performed with local anesthesia and those performed with the WALANT. Methods: In this prospective study, 60 CTS were operated in two different institutions. Patients in group 1 (30 patients) were operated under LA-T, while patients in group 2 (30patients) were operated on using lidocaine with epinephrine (WALANT). Statistical analysis was performed. Results: Postoperative pain immediately after surgery, at 4 and 24 hours, and 15, and 30 days after surgery; and degree of satisfaction did not show a significant difference between the two groups. Moreover, surgical time was slightly shorter in the LA-T group, but the difference was not significant. Conclusion: In our study, CTD performed with LA-T, and WALANT technique resulted in similar results. In cases of experienced surgeons, LA-T may be enough to perform the procedure, avoiding epinephrine's low but complex complications. In less experienced surgeons who require more surgical time, the use of WALANT may increase the intraoperative comfort of the patient.

The use of the double uterine segment tourniquet in obstetric hysterectomy for bleeding control in patients with placenta accreta spectrum.

OBJECTIVES: To evaluate surgical outcomes of using a double uterine segment tourniquet in obstetric hysterectomy for bleeding control in patients with placenta accreta spectrum. METHODS: Retrospective case-control study conducted at the Central Hospital of San Luis Potosi, Mexico. Patients with the diagnosis of placenta accreta spectrum who underwent obstetric hysterectomy were included. Two groups were formed: in the first, a double uterine segment tourniquet was used; and in the second, the hysterectomy was performed without a tourniquet. Primary surgical outcomes were compared. RESULTS: Forty patients in each group were included. The use of a double uterine segment tourniquet had lower total blood loss compared with the non-tourniquet group (1054.00 ± 467.02 vs. 1528.75 ± 347.12 mL, P = 0.0171) and a lower drop in hemoglobin (1.74 ± 1.10 vs. 2.60 ± 1.25 mg/dL, P = 0.0486). Ten patients (23.80%) in the double tourniquet group required blood transfusion, compared with 26 (65.00%) in the non-tourniquet group (P = 0.0003). Surgical time did not show a statistical difference between groups. CONCLUSION: The use of a uterine segment tourniquet in obstetric hysterectomy may improve surgical outcomes in patients with placenta accreta spectrum with no difference in surgical time and urinary tract lesions.

What Is the Infection Rate of Carpal Tunnel Syndrome and Trigger Finger Release Performed Under Wide-Awake Anesthesia?

BACKGROUND: High infection rates have been reported in hand procedures using the wide-awake local anesthesia no tourniquet (WALANT) method, causing some to question the validity of this approach. However, little evidence exists surrounding the direct use of WALANT compared with monitored anesthetic care (MAC). This study was conducted to directly compare the postoperative infection rates of carpal tunnel syndrome (CTS) and trigger finger (TF) release surgeries performed under WALANT and MAC. METHODS: A retrospective study comparing postoperative infection rates between patients undergoing CTS and TR releases was conducted. Our primary outcome measure was postoperative infection. Our secondary outcome was postoperative complications. Comparative statistics were used to compare means of infection between the groups. RESULTS: A total of 526 patients underwent CTS release (255 with WALANT and 271 with MAC), and 129 patients underwent TF release (64 with WALANT and 65 with MAC). Patients undergoing WALANT and MAC were statistically comparable in terms of sex, smoking status, diabetes, and American Society of Anesthesiologists physical status classification. In patients undergoing CTS release, there were no infections with WALANT and 6 infections (2.2%) with MAC. In patients undergoing TF release, there were no infections in either group. There were similar rates of complications in patients undergoing WALANT and MAC for CTS and TF releases. CONCLUSION: There was no increased risk of infection with WALANT compared with MAC in CTS or TR surgeries. These surgeries can be safely conducted with lidocaine and epinephrine without a concern for increased risk of infections or complications.

Optimized Tourniquet Use in Primary Total Knee Arthroplasty: A Comparative, Prospective, and Randomized Study.

BACKGROUND: The results of recent studies investigating tourniquet (TNQ) use for knee arthroplasty are controversial. Therefore, this study aimed to compare patients undergoing total knee arthroplasty who did not have a TNQ to those in whom an optimized TNQ protocol was applied. METHODS: We prospectively evaluated 127 patients who had knee osteoarthritis who had undergone total knee arthroplasty and randomized them into two groups: "without TNQ" and "optimized TNQ" (TNQ inflation before skin incision, deflation after cementing, with pressure one hundred millimeters of mercury above the systolic blood pressure, and without articular suction drain usage). The means of surgery and TNQ duration, blood loss, number of blood transfusions, degree of pain, edema, range of motion (ROM), functional score over time, and postoperative complications were compared between the groups. Statistical significance was set at P < .05. RESULTS: No significant differences were found in terms of surgical timing, blood loss, thigh and knee pain, edema, ROM, functional scores, and complications between the "without TNQ" and "optimized TNQ" groups. CONCLUSION: The use of an optimized TNQ in primary total knee arthroplasty presents similar clinical results to surgery without a TNQ and did not increase the incidence of postoperative complications. Its use allowed surgery to occur with the benefits of a clean and dry surgical field provided by TNQ without increasing procedure-related comorbidities.

The Brazilian Perspective of WALANT in Fracture Fixation From the Hand to the Elbow.

The wide-awake local anesthesia no tourniquet (WALANT) technique is currently being used by several hand surgeons. This technique enables surgeries to be performed with the patient fully awake and without a tourniquet, thus allowing the intraoperative assessment of function. The purpose of this article was to describe our WALANT techniques for metacarpal, scaphoid, distal radius, radial head, and olecranon fracture fixation with its pearls and pitfalls. The authors demonstrate their infiltration technique, detailing how to perform it using lidocaine with 1:100,000 epinephrine and 8.4% sodium bicarbonate. The authors describe where to start the tumescent anesthesia in each type of fracture described. To achieve a painless surgery under WALANT, it is crucial to administer the subcutaneous anesthetic injection around the incision site and at the periosteum to surround the entire fractured bone circumferentially. Before making the incision, the fracture site must be manipulated and the patient should not experience any pain. As a routine in every WALANT procedure, we wait at least 25 minutes to start the surgery, as this is the optimal time interval to achieve maximal vasoconstriction within the limits of tumescent anesthesia. In all operated cases, it was possible to conduct intraoperative assessment of the range of motion of the elbow, wrist, hand, and fingers, in addition to evaluating the fixation stability through active motion and ensuring earlier rehabilitation.

The Impact of Intraoperative Nursing Care on Perioperative Complications During Wide-Awake Local Anesthesia Hand Surgery.

Purpose: The wide-awake local anesthesia technique in hand surgery is widely used, but there are currently no guidelines or protocols for the number of operating room personnel required to optimize patient safety intraoperatively. This study aimed to evaluate perioperative complication rates of wide-awake local anesthesia hand surgeries performed at surgery centers that used different numbers of operating room nurses. Methods: We conducted a retrospective review of patients who underwent wide-awake local anesthesia hand surgery at 4 surgical centers over a 30-month consecutive period. Two surgical centers used 3 operating room nurses, and 2 centers used 2 operating room nurses. The complications reported included intraoperative case abortion because of critical change in patient vitals, intraoperative medication delivery, intraoperative intravenous placement for medication delivery, intraoperative conversion to sedation, intraoperative medical complications, and postoperative transfer to the emergency department or a hospital. Results: A total of 1,771 wide-awake local anesthesia surgical procedures were identified, with 925 performed at a facility that used 2 operating room nurses and 846 performed at a facility that used 3 operating room nurses. There were no perioperative complications in either group during the study period. Conclusions: There was no difference in perioperative complications between the surgery centers that used 3 versus 2 intraoperative nurses during wide-awake local anesthesia hand surgery. This study supports that limiting the nursing personnel for wide-awake local anesthesia hand surgeries could be an efficient way to cut procedural costs without compromising patient safety. Type of study/level of evidence: Therapeutic IV.

Economic and Environmental Impacts of the Wide-Awake, Local Anesthesia, No Tourniquet (WALANT) Technique in Hand Surgery: A Review of the Literature.

The United States spends more on health care than any other country in the world based on the percentage of gross domestic product. This fact is coupled with health care facilities contributing nearly one-tenth of all greenhouse gas emissions in the United States, and with the health care industry's waste contributions to landfills being second only to those of the food industry. In some instances, operating rooms produce the majority of total landfill waste from hospitals; therefore, patients undergoing surgical procedures can have both financial and environmental impacts. Recently, the wide-awake, local anesthesia, no tourniquet technique in hand surgery has grown in popularity. This technique has reportedly allowed surgeons to decrease operating room costs, time, and waste, but without compromising patient safety or outcomes. This comprehensive literature review summarizes the current literature related to the economic and environmental impacts of the wide-awake, local anesthesia, no tourniquet technique in hand surgery.

Penile hair tourniquet to base of penis resulting in circumferential separation of shaft skin without vascular compromise: An unusual case report.

Hair tourniquet syndrome occurs when a strand of hair or thread becomes wrapped around an appendage, causing injury which can progress to ischemia, necrosis or autoamputation. A 2 year old uncircumcised male presented with 1 day of erythema to base of penis followed by a bleeding wound of 5 hours duration. On examination, there was circumferential separation of shaft skin at the base of the penis. Examination of diaper revealed a coiled strand of maternal hair. Debridement and primary repair were done, with an uneventful recovery. This represents an unusual presentation, as both the site and pattern of injury were atypical.

Are cementation quality and clinical outcomes affected by the use of tourniquet in primary total knee arthroplasty?

INTRODUCTION: Total knee arthroplasty is used to treat end-stage knee osteoarthritis with great results. Tourniquet use has become popular over the years because of its various benefits, but the literature regarding functional outcomes, pain and rehabilitation and comparison between tourniquet use and improvement cement penetration and overall improve fixation is limited. The authors proposed a hypothesis that cementation quality, and clinical outcomes can be influenced by tourniquet technique. METHODS: Fifty patients were allocated randomly in two groups: (1) tourniquet was inflated throughout all the procedure and (2) only during skin incision and cementation. Radiolucent lines were analyzed by two and independent examiners, using the The Knee Society Roentgenographic Evaluation and Scoring System. The functional scores used were the Oxford knee score and improvement in visual pain scale (VAS). RESULTS: After a mean follow-up period of 2.4 ± 0.2 years, no difference was observed regarding partial use of tourniquet in the cementation quality (p value > 0.05). There was no difference between groups regarding gender, age, knee side, Visual VAS, Oxford Score, total range-of-motion (ROM), knee extension and knee flexion (p value > 0.05). CONCLUSIONS: No difference was attained regarding functional outcomes and cementation quality regarding two different tourniquet protocols.

Incidence and risk factors for acute kidney injury: a prospective, randomized, single-blind clinical trial comparing total knee arthroplasty with and without tourniquet.

PURPOSE: Identify the incidence and risk factors for acute kidney injury (AKI) following total knee arthroplasty (TKA) with and without tourniquet. MATERIAL AND METHODS: 100 patients were randomized into two groups. Postoperative AKI was defined as the postoperative creatinine level 0.3 mg/dl compared with baseline. Potential variables associated with AKI were analyzed by multivariate logistic regression model to identify the AKI risk factors in TKA patients with and without tourniquet. RESULTS: AKI rate was 22%, tourniquet use (OR = 2.66, p = 0.014), blood loss > 500 cm3 (OR = 3.99, p = 0.001), postoperative Hb < 10 g/dl (OR = 2.68, p = 0.008), blood transfusions (OR = 2.86, p = 0.012) and diabetes (OR = 2.80, p = 0.006) were associated with increased risk of postoperative AKI. CONCLUSIONS: The use of tourniquet should be indicated with caution and should not be used routinely in patients with other risk factors for the development of acute kidney dysfunction, other measures to achieve trans-surgical hemostasis should be implemented in our environment to reduce the incidence of acute kidney dysfunction related to the use of the tourniquet.

PROPÓSITO: Identificar la incidencia y factores de riesgo para lesión renal aguda (LRA) después de la artroplastia total de rodilla (ATR) con y sin uso de torniquete. MATERIAL Y MÉTODOS: Se dividieron 100 pacientes en dos grupos. Se definió la LRA como una elevación postoperatoria de la creatinina 0.3 mg/dl comparada con el nivel basal preoperatorio. Las potenciales variables asociadas con la DRA fueron analizadas con un modelo de regresión logística multivariada para identificar los factores de riesgo de DRA en pacientes sometidos a ATR con y sin torniquete. RESULTADOS: La incidencia de LRA fue de 22%. El uso de torniquete (OR = 2.66, p = 0.014), pérdida sanguínea > 500 cm3 (OR = 3.99, p = 0.001), Hb postoperatoria < 10 g/dl (OR = 2.68, p = 0.008), transfusión sanguínea (OR = 2.86, p = 0.012) y la diabetes (OR = 2.80, p = 0.006) fueron asociados a un mayor riesgo postoperatorio de LRA. CONCLUSIONES: El uso de torniquete debe estar indicado con precaución y no debe utilizarse de forma rutinaria en pacientes con otros factores de riesgo para el desarrollo de disfunción renal aguda, otras medidas para lograr la hemostasia transquirúrgica deben implementarse en nuestro entorno para reducir la incidencia de disfunción renal aguda relacionada con el uso del torniquete.

Optimizing Tourniquet Pressure in Upper Extremity Surgery.

Background: Pneumatic tourniquet is an effective tool to achieve hemostatic control of the surgical field in upper extremity (UE) operations. Elevated pressures have been associated with adverse effects despite various methods of pressure determination. We aim to demonstrate the usage of reduced tourniquet pressures and examine factors associated with achieving reduced pressures. Methods: A prospective study was conducted (2016-2018) at a Level 1 Trauma Center and an Outpatient Surgical Center, totaling 226 operations, involving a reduction of cuff pressures over time from a standard baseline of limb occlusion pressure for UE operations. Results: A gradual reduction of pressures was successfully achieved with a mean pressure of 187 mmHg and average time of tourniquet application being 25 minutes. We found chronological surgical number and patient BMI to be significantly associated with tourniquet pressure (p < 0.05). 4.5% of cases resulted in breakthrough bleeding, but did not reliably occur with any pressure thresholds, patient demographics, or operative factors (p > 0.05, for all). Conclusions: Reduced tourniquet pressures can mitigate complications associated with tourniquet use. Our research shows reduced pressures are successful in maintaining field visibility and we encourage an adoption of pressures below 200 mm Hg in most procedures that require a tourniquet.