Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2013 Apr;84(2):159-64.
doi: 10.3109/17453674.2013.782525. Epub 2013 Mar 14.

Tourniquet cuff pressure and nerve injury in knee arthroplasty in a bloodless field: a neurophysiological study

Charlotta Olivecrona  1 , Richard Blomfeldt, Sari Ponzer, Benjamin Ribalta Stanford, Bengt Y Nilsson
Affiliations
Randomized Controlled Trial

Tourniquet cuff pressure and nerve injury in knee arthroplasty in a bloodless field: a neurophysiological study

Charlotta Olivecrona et al. Acta Orthop. 2013 Apr.

Abstract

Background and purpose: Tourniquet-related nerve injuries remain a concern in orthopedic surgery. The cuff pressures used today are generally lower, and therefore a decreasing incidence of peripheral nerve injuries might also be expected. However, there have been few neurophysiological studies describing the outcome after bloodless field surgery. We describe the results of neurophysiological examinations and report the incidence of nerve injuries after total knee arthroplasty (TKA) in a bloodless field.

Patients and methods: This study was part of a prospective, randomized controlled clinical trial in patients scheduled for TKA in a bloodless field. 20 consecutive patients were enrolled. Electroneurography (ENeG) and quantitative sensory testing (QST) of thermal thresholds were performed on day 3. These tests were repeated 2 months after surgery when electromyography (EMG) with a concentric-needle electrode was also performed.

Results: The mean tourniquet cuff pressure was 237 (SD 33) mmHg. Electromyographic signs of denervation were found in 1 patient, who also had the highest cuff pressure in the study population (294 mmHg). The sensory nerve response amplitudes were lower in the operated leg on day 3; otherwise, the neurophysiological examinations showed no differences between the legs.

Interpretation: When low tourniquet cuff pressures are used the risk of nerve injury is minor.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
F-wave latency (in ms) and F-wave persistence (%) in the peroneal nerve in the operated leg both at day 3 and 2 months postoperatively. Patient no. 16 had EMG-confirmed nerve injury and the highest cuff pressure of 294 mmHg.
Figure 2.
Figure 2.
F-wave latency (in ms) and F-wave persistence (%) in the tibial nerve in the operated leg both at day 3 and 2 months postoperatively. Patient no. 16 had EMG-confirmed nerve injury and the highest cuff pressure of 294 mmHg. Patient no. 12 had the longest bloodless field duration of 122 minutes.
See this image and copyright information in PMC

References

    1. Alcelik I, Pollock RD, Sukeik M, Bettany-Saltikov J, Armstrong PM, Fismer P. A comparison of outcomes with and without a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty. 2012;27(3):331–40. - PubMed
    1. Aminoff MJ. Electrophysiologic testing for the diagnosis of peripheral nerve injuries. Anesthesiology. 2004;100(5):1298–303. - PubMed
    1. Arciero RA, Scoville CR, Hayda RA, Snyder RJ. The effect of tourniquet use in anterior cruciate ligament reconstruction. A prospective, randomized study. Am J Sports Med. 1996;24(6):758–64. - PubMed
    1. Dahlin LB, Shyu BC, Danielsen N, Andersson SA. Effects of nerve compression or ischaemia on conduction properties of myelinated and non-myelinated nerve fibres. An experimental study in the rabbit common peroneal nerve. Acta Physiol Scand. 1989;136(1):97–105. - PubMed
    1. Dobner JJ, Nitz AJ. Postmeniscectomy tourniquet palsy and functional sequelae. Am J Sports Med. 1982;10(4):211–4. - PubMed

Publication types