Assessment of complications following use of pneumatic tourniquet for elective orthopedic procedures at National Orthopedic Hospital, Enugu

Authors

  • Remigius T. Ekwunife Department of Orthopedics, National Orthopedic Hospital, Enugu
  • Emmanuel C. Iyidobi Department of Orthopedics, National Orthopedic Hospital, Enugu
  • Ugochukwu M. Enweani Department of Orthopedics, City Specialist Hospital, Enugu
  • Cajetan U. Nwadinigwe Department of Orthopedics, National Orthopedic Hospital, Enugu
  • Charles I. Okwesili Department of Surgery, College of Medicine, University of Nigeria, Enugu Campus
  • Henry C. Ekwedigwe Department of Orthopedics, Enugu State University Teaching Hospital Parklane, Enugu
  • Emmanuel O. Agbo Department of Orthopedics, National Orthopedic Hospital, Enugu

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20193822

Keywords:

Pneumatic tourniquet, Elective, Orthopaedic procedures, Complications

Abstract

Background: A pneumatic tourniquet is a constricting or compressing device with an inflatable cuff used to control venous or arterial circulation to an extremity for a period of time. Tourniquet safety is related to the cuff pressure and duration of application. The objective of this study was to determine the common complications that follow the use of pneumatic tourniquet in elective orthopaedic surgical procedures at National Orthopaedic Hospital Enugu.

Methods: This was a prospective study over 18 month period (June 2014 – November 2015) at National Orthopaedic Hospital, Enugu. Following ethical approval and written informed consent, patients who met the inclusion criteria were consecutively recruited. The study was conducted using the ‘intelligent pneumatic tourniquet’ with single bladder reusable cylindrical cuff. The cuff pressure was determined in each case by addition of 100mmHg to the baseline systolic BP for the upper limbs and 150 mmHg to the baseline systolic BP for the lower limbs. The data collected included patients’ demographics, cuff pressure, cuff location, tourniquet duration and complication encountered among other parameters.

Results: A total of 160 procedures in 152 patients were included and analyzed using SPSS version 20.0. The prevalence rate of 1.9% for nerve palsy, 1.3% for tourniquet pain, 1.9% for surgical site infection and 5.6% for pressure sore were found in the study. No other complication was encountered.

Conclusions: From the results of this study, it is concluded that the use of pneumatic tourniquet under the prescribed conditions is associated with low prevalence of complications.

Author Biography

Remigius T. Ekwunife, Department of Orthopedics, National Orthopedic Hospital, Enugu

ORTHOPAEDICS AND TRAUMA

CONSULTANT ORTHOPAEDIC/TRAUMA SURGEON.

References

Tourniquet. The Free Encyclopedia. Available at: http://www.en.wikipedia.org/ wiki/tourniquet. Accessed on 20 August 2019.

Murphy CG, Winter DC, Bouchier-Hayes DC. Tourniquet Injuries: Pathogenesis and Modalities for Attenuation. Acta Orthop Belg. 2005;71:635-45.

McEwen JA. US Patent, No.4,469,099. “Pneumatic Tourniquet”. September 4, 1984.

McEwen JA. US Patent No 4,479,494. “Adaptive Pneumatic Tourniquet”. October 30, 1984.

Udosen AM. The use of tourniquet in orthopaedic surgery: a prospective study of the effect of tourniquet use on incidence of postoperative wound infection. A dissertation submitted to the NPMCN. 1999: 1-34.

Ogbemudia AO. Composite sterile aneroid sphygmomanometer and rubber bandage tourniquet: indications, techniques and results. Internet J Orthopaed Surg. 2006;(2).

Reid HS, Camp RA, Jaco, WH. Tourniquet hemostasis: a clinical study. Clin Orthopaed. 1983;177:230-4.

Tourniquet Use and Care. Available AT: http://www.tourniquets.org. Accessed on 20 August 2019.

Braithwaite I, Klenerman L. Burns under the Tourniquet-Bruner’s Ten Rules Revisited. J Med Dent Defence Union. 1996;12:14-5.

Carter KB, Shaw A, Telfer AB. Tourniquets for Surgery: Safety Aspects. J Med Eng Technol. 1983;7:136-9.

Jahss M. Disorders of the Foot and Ankle. Medical and Surgical Management. 2nd edition. Philadelphia: WB Saunders; 1991: 55-56.

Flatt AE. Tourniquet in Hand Surgery. Arch Surg. 1972;104:190-2.

Odinsson A, Finsen V. Tourniquet Use and Its Complications in Norway. J Bone Joint Surg [Br]. 2006;88:1090-2.

Bolton CF, McFarlane RM. Human Pneumatic Tourniquet Paralysis. Neurol. 1978;28:787-93.

Rorabeck CH, Kennedy JC. Tourniquet-Induced Nerve Ischaemia Complicating Knee Ligament Surgery. Am J Sports Med. 1980;8:98-102.

Saunders KC, Louis DL, Weingarden SI, Waylonis GW. Effect of Tourniquet Time on Postoperative Quadriceps Function. Clin Orthop. 1979;143:194-9.

Aho K, Sainio K, Kianta M, Varpanen E. Pneumatic Tourniquet Paralysis. Case Report. J Bone Joint Surg [Br]. 1983;65(4):441-3.

Noordin S, Mc Ewen JA, Kragh JF, Eisen A, Masri B. A. Surgical Tourniquets in Orthopaedics. J Bone Joint Surg Am. 2009;91:2958-67.

Enweani UN. Surgical Wound Sepsis in Clean Orthopaedic Procedures Bacteriology and Sensitivity in a Regional Specialist Centre. Oreint Journ Med. 1991;3(1):3-6.

Salam AA, Eyres KS, Cleary J, EL- Sayed H. The Use of Tourniquet when Plating Tibal Fractures. J Bone Joint Surg [Br]. 1991;73:86-7.

Middleton RWD, Varian JPW. Tourniquet Paralysis. Aust NZ Journ Surg. 1974;44:124-8.

Sunderland S. Nerves and Nerve Injuries. Edinburgh and London: E&S Livingstone; 1968.

Speigel IJ, Lewin P. Tourniquet Paralysis. JAMA. 1945;129:432-5.

Chiu D, Wang HH, Blumenthal MR. Creatine Phosphokinase Release as a Measure of Tourniquet Effect on Skeletal Muscle. Arch Surg. 1976;111:71-4.

Heppenstall RB, Balderston R, Goodwin C. Pathophysiologic Effects Distal to a Tourniquet in the Dog. J Trauma. 1979;19:234-8.

Klenerman L. The Tourniquet in Operations on the Knee: A Review. J R Soc Med. 1982;75:31-2.

Klenerman L. Tourniquet Time- How Long? The Hand. 1980;12:231-4.

Oragui E, Parsons A, White T, Longo UG, Khan WS. Tourniquet Use in Upper Limb Surgery. Hand. 2011;6:165-73.

Ogufere WE, Giddins GEB, Thom JS. Upper Arm Tourniquet pain in Local Anaesthetic surgery. J Hand Surg. 1995;20:413-4.

Subspecialty Management, Complications of Orthopaedic Surgery. Available at: http://www. squ.edu.om//040404r00.htm. Accessed 20 August 2019.

Downloads

Published

2019-08-26

Issue

Section

Original Research Articles