Mechanical Tourniquet Research Articles

Effects of Tourniquet Features on Application Processes.

We investigated emergency-use limb tourniquet design features effects on application processes (this paper) and times to complete those processes (companion paper). Sixty-four appliers watched training videos and then each applied all eight tourniquets: Combat Application Tourniquet Generation 7 (CAT7), SOF™ Tactical Tourniquet-Wide Generation 3 (SOFTTW3), SOF™ Tactical Tourniquet-Wide Generation 5 (SOFTTW5), Tactical Mechanical Tourniquet (TMT), OMNA Marine Tourniquet (OMT), X8T tourniquet (X8T), Tactical Ratcheting Medical Tourniquet (Tac RMT), and RapidStop™ Tourniquet (RST). Application processes were scored from videos. Thirty-three appliers had no prior tourniquet experience. All 512 applications were placed proximal to the recipient's simulated distal thigh injury. Thirty-one appliers (13 with no experience) had 66 problem-free applications (18 by no experience appliers). Tightening-system mechanical problems were more frequent with windlass rod systems (26 losing hold of the rod, 27 redoing rod turns, and 58 struggling to secure the rod) versus ratchet systems (3 tooth skips and 16 advance failures). Thirty-five appliers (21 with no experience) had 68 applications (45 by no experience appliers) with an audible Doppler pulse when stating "Done"; causes involved premature stopping (53), inadequate strap pull (1 SOFTTW3, 1 RST), strap/redirect understanding problem (1 SOFTTW5, 1 X8T, 4 Tac RMT, 1 RST), tightening-system understanding problem (2 CAT7, 1 SOFTTW3, 1 TMT, 1 RST), and physical inability to secure (1 SOFTTW3). Fifty-three appliers (32 no experience) had 109 applications (64 by no experience appliers) not correctly secured. Six involved strap/redirect understanding problems: 4 Tac RMT, 1 X8T, 1 SOFTTW5; 103 involved improper securing of non-self-securing design features: 47 CAT7 (8 strap, 45 rod), 31 TMT (17 strap, 19 rod), 22 OMT (strap), and 3 SOFTTW3 (rod). Self-securing systems have process advantages. Because most emergent tourniquet recipients require transport, we believe tourniquet security is a critical design aspect. Decisions regarding tourniquet choices may become very different when both occlusion and tourniquet security are considered.

Effects of Tourniquet Features on Application Processes Times.

We investigated emergency-use limb tourniquet design features effects on application processes (companion paper) and times to complete those processes (this paper). Sixty-four appliers watched training videos then each applied all eight tourniquets: Combat Application Tour- niquet Generation 7 (CAT7), SOF™ Tactical Tourniquet-Wide Generation 3 (SOFTTW3), SOF™ Tactical Tourniquet-Wide Generation 5 (SOFTTW5), Tactical Mechanical Tourniquet (TMT), OMNA Marine Tourniquet (OMT), X8T-Tourniquet (X8T), Tactical Ratcheting Medical Tourniquet (Tac RMT), and RapidStop Tourniquet (RST). Application processes times were captured from videos. From "Go" to "touch tightening system" was fastest with clips and self-securing redirect buckles and without strap/redirect application process problems (n, median seconds: CAT7 n=23, 26.89; SOFTTW3 n=11, 20.95; SOFTTW5 n=16, 20.53; TMT n=5, 26.61; OMT n=12, 25.94; X8T n=3, 18.44; Tac RMT n=15, 30.59; RST n=7, 22.80). From "touch tightening system" to "last occlusion" was fastest with windlass rod systems when there were no tightening system understanding or mechanical problems (seconds: CAT7 n=48, 4.21; SOFTTW3 n=47, 5.99; SOFTTW5 n=44, 4.65; TMT n=38, 6.21; OMT n=51, 6.22; X8T n=48, 7.59; Tac RMT n=52, 8.44; RST n=40, 8.02). For occluded, tightening system secure applications, from "touch tightening system" to "Done" was fastest with self-securing tightening systems tightening from a tight strap (occluded, secure time in seconds from a tight strap: CAT7 n=17, 14.47; SOFTTW3 n=22, 10.91; SOFTTW5 n=38, 9.19; TMT n=14, 11.42; OMT n=44, 7.01; X8T n=12 9.82; Tac RMT n=20, 6.45; RST n=23, 8.64). Suboptimal processes in- crease application times. Optimal design features for fast, occlusive, secure tourniquet applications are self-securing strap/ redirect systems with an easily identified and easily used clip and self-securing tightening systems.

Comparison Of Non-clinical Tourniquet Research for Appliance Superiority & Tolerance (CONTRAST)

BACKGROUND: Tourniquets are effective tools to manage life-threatening extremity hemorrhage. Commercial devices are recommended over improvised ones; however, mass casualty incidents and austere environments may prevent access to commercial devices. The aim of this review is to systematically search and meta-analyze commercial and improvised tourniquets: arterial occlusion, application speed, and patient tolerance. METHODS: We searched MEDLINE, Embase, CINAHL, Cochrane Library, SPORTDiscus, and ProQuest Dissertations & Theses Global using controlled terms; without date limits. Manikin, animal, and operative studies were excluded. Tourniquet devices were pooled by design and compared. Data regarding provider training and experience, recipient anthropometrics, application site, ease of application, speed, tolerance, and device efficacy were examined. RESULTS: 5169 studies were screened. The 36 included studies were prospective trials on healthy volunteers and published between 2000 and 2021. There were 8205 unique tourniquet applications to 1921 subjects using 23 unique commercial and improvised devices. Median sample size of included studies was 20 (IQR 26) participants, ranging from 1 to 773 participants; and 102 (IQR=152) applications ranging from 20 individual applications to 1546 unique applications. The most commonly assessed outcomes were: effectiveness (n=30), pain (n=18), speed of application (n=13), and amount of mechanical advantage (ex. Windlass turns) required (n=13). Male participants outnumbered females 1,414 to 169, mean age ranged from 21 to 45 years of age. Devices were pooled into 5 categories according to mechanical advantage mechanism: elastic, friction, mechanical, pneumatic, and windlass. Initial hemostasis was achieved in 95% of upper extremity placements (CI=0.89-0.98, p= 0.02), and 88% of mid-thigh applications (CI=0.78-0.94, p>0.01), in both groups pneumatic and mechanical tourniquet devices had the highest rates of success, with friction and elastic devices having the lowest rates of success. Meta-analysis showed that mechanical and pneumatic advantage systems had superior rates of hemostasis, ease of use, and pain tolerance scores. Due to study heterogeneity, we could not determine which devices were the fastest to apply. The overall risk of bias assessment for included studies found the certainty of studies ranged from moderate to critical. CONCLUSION: In pre-clinical studies mechanical and pneumatic advantage systems appear to be the superior tourniquet design. Due to the low certainty of evidence and non-randomizable nature of traumatic injury, pre-clinical tourniquet devices will likely continue to be tested on well volunteers. Adoption of a minimum data set, agreed upon definitions for testable metrics, and a standardized experimental design could improve the comparability and quality of future tourniquet device studies.

Measures to Reduce Perioperative and Intraoperative Blood Loss at Myomectomy: A Survey of Obstetrician-Gynaecologists.

This study sought to determine current techniques used by Canadian obstetrician-gynaecologists (OB/GYNs) to medically optimize patients undergoing myomectomy during the perioperative and intraoperative periods and to identify gaps in knowledge or barriers to access of blood conservation methods. From September to December 2016, a self-administered electronic questionnaire was distributed to 120 Canadian OB/GYNs who perform myomectomies and who practise in either academic, community, or community academic-affiliated hospitals. A total of 68 of 120 (57%) completed responses were analyzed. Most respondents were general OB/GYNs (72.1%; n = 49) who worked in the community (70.6%; n = 48) and had practised >10 years (67.7%; n = 46); 79.4% (n = 54) delayed surgery to correct anemia. The most common preoperative medical agents used included tranexamic acid (94.1%), ulipristal acetate (92.6%), gonadotropin-releasing hormone agonist (79.4%), and combined hormonal contraception (58.8%). The majority had access to hematology (83.8%; n = 57) and intravenous iron (82.4%; n = 56). However, respondents had variable knowledge of oral and intravenous iron dosing and administration. The most common intraoperative agents used included vasopressin (94.1%; n = 64 [subserosal, 59.4% vs. intramyometrial, 40.6%]), vasopressin with epinephrine (26.6%; n = 17 [subserosal, 58.8% vs. intramyometrial, 41.2%]), intravenous tranexamic acid (73.5%; n = 50), mechanical tourniquet (66.2%; n = 45), misoprostol (33.8%; n = 23), uterine artery ligation (22.1%; n = 15), topical sealant (17.6%; n = 12), and intraoperative blood salvage (11.8%; n = 8). Most OB/GYNs delay surgery to correct anemia, but they are uncertain of personal and institutional transfusion rates, iron dosing and administration, and optimal multimodal approaches to minimize intraoperative blood loss during myomectomy. Education and creation of a clinical pathway to address blood conservation may decrease perioperative morbidity for patients undergoing myomectomy.

Uterine Artery Tourniquet Versus Vaginal Misoprostol to Decrease Blood Loss during Transabdominal Myomectomy

Background: Uterine fibroids are tumor of the smooth muscles and the connective tissue of the uterus. They are considered to be the most common benign tumor of the pelvis. Conservative surgery remains the main approach for management of uterine myomas. Myomectomy is considered to be an important option for women who desire future childbearing or simply want to preserve their uterus. Objective: The aim of the study was to compare between the effect of pericervical uterine artery tourniquet (surgical) and perioperative vaginal misoprostol (medical) regarding their efficacy to decrease blood loss during trans- abdominal myomectomy. Methods: Prospective randomized controlled clinical trial. The study was approved by the Ethical Research Committee. The study was conducted in Obstetrics and Gynecology Department, Zagazig University Hospital. The study included 36 women with symptomatic myomas randomized into Group A included 18 patients who underwent uterine artery tourniquet and Group B included 18 patients who received single dose of 400 μg vaginal misoprostol one-hour before surgery. Results: The present study showed that there was statistically significant difference between both groups regarding intra-operative blood loss, operative time, the need for blood transfusion and amount of fluid within the post-operative drain. Conclusion: Pericervical mechanical tourniquet in comparison with pre-operative vaginal misoprostol is more effective method in; reducing both intra-operative and post-operative blood loss, and shortening of operative time during transa-bdominal myomectomy.

Best Tourniquet Holding and Strap Pulling Technique.

Appropriate strap pressure before tightening-system use is an important aspect of nonelastic, limb tourniquet application. Using different two-handed techniques, the strap of the Generation 7 Combat Application Tourniquet (C-A-T7), Tactical Ratcheting Medical Tourniquet (Tac RMT), Tactical Mechanical Tourniquet (TMT), Parabelt, and Generation 3 SOF® Tactical Tourniquet-Wide (SOFTTW) was secured mid-thigh by 20 appliers blinded to pressure data and around a thigh-sized ballistic gel cylinder by gravity and 23.06kg. Pulling only outward (90° to strap entering buckle) achieved the lowest secured pressures on thighs and gel. For appliers, the best holding location was above the buckle, and the best strap-pulling direction was tangential to the thigh or gel (0° to strap entering buckle). Preceding tangential pulling with outward pulling resulted in higher secured pressures on the gel but did not aid appliers. Appliers generally did not reach secured pressures achievable for their strength. Of 80 thigh applications per tourniquet, 77 C-A-T7, 41 Tac RMT, 35 TMT, 16 Parabelt, and 10 SOFTTW applications had secured pressures greater than 100mmHg. The default for best tourniquet strap-application technique is to hold above the buckle and pull the strap tangential to the limb at the buckle. Additionally, neither strength nor experience guarantees desirable strap pressures in the absence of pressure knowledge.

From Pull to Pressure: Effects of Tourniquet Buckles and Straps

Limb tourniquet pressures > 100 mmHg before tightening system use eases achieving arterial occlusion, minimizes tightening system problems, and probably minimizes discomfort. This study examined effects of buckle and strap features on converting pulling force to strap pressure. Twenty-two buckle and strap combinations were evaluated using a thigh-diameter, ballistic gel cylinder and 3 thighs. Weights of 14.11, 27.60, and 41.11 kg provided pulling force. The contribution of buckle movement was evaluated: all buckles on gel and 12 on thighs allowed limited vertical movement, 12 on gel and 4 on thighs held static. Force conversion patterns per combination were similar on gel and thighs, including greatest force conversion with some buckle movement allowed. Smooth, round redirect buckles without engagement of a strap-securing mechanism had the best conversions of pulling force to tourniquet pressure; 2 achieved arterially occlusive pressures, neither commercially available. Among hook-and-loop secured tourniquets and threaded for self-securing tourniquets, the Generation 7 Combat Application Tourniquet (C-A-T7) and the Tactical Ratcheting Medical Tourniquet (Tac RMT) had the best conversions of pull to pressure (thigh applications/each weight, mean ± SD: C-A-T7 91 ± 11, 164 ± 30, 228 ± 34 mmHg; Tac RMT 82 ± 13, 150 ± 16, 222 ± 17 mmHg). Other Ratcheting Medical Tourniquets with the same buckle but different strap fabrics performed less well. Even lower pressures occurred with the Tactical Mechanical Tourniquet, the Special Operations Forces Tactical Tourniquet, the Parabelt, and the SAM XT Extremity Tourniquet (165 ± 11, 178 ± 13, 131 ± 14, and 106 ± 14 mmHg, all at 41.11 kg, respectively). Buckle design and strap fabric affect the conversion of pulling force to tourniquet strap pressure. Low-friction, smooth, round redirects allow the best conversion.

The Combat Application Tourniquet Versus the Tactical Mechanical Tourniquet.

Exsanguination from limb injury is an important battlefield consideration that is mitigated with the use of emergency tourniquets. The Combat Application Tourniquet (C-A-T®) is the current British military standard tourniquet. We tested the self-application of a newer tourniquet system, the Tactical Mechanical Tourniquet (TMT), against self-application of the C-A-T. A total of 24 healthy British military volunteers self-applied the C-A-T and the TMT to their mid thigh in a randomized, sequential manner. Popliteal artery flow was monitored with a portable ultrasound machine, and time until arterial occlusion was measured. Pain scores were also recorded. Results The volunteers allowed testing on their lower limbs (n = 48 legs). The C-A-T was applied successfully to 22 volunteers (92%), and the TMT was successfully applied to 17 (71%). Median time to reach complete arterial occlusion was 37.5 (interquartile range [IQR], 27-52) seconds with the C-A-T, and 35 (IQR, 29-42) seconds with the TMT. The 2.5-second difference in median times was not significant (ρ = .589). The 1-in-10 difference in median pain score was also not significant (ρ = .656). The success or failure of self-application between the two tourniquet models as assessed by contingency table was not significant (p= .137). The TMT is effective when self-applied at the mid thigh. It does not offer an efficacy advantage over the C-A-T.

188 - Measures to Reduce Peri- and Intra-Operative Blood Loss at Myomectomy: a Survey of Obstetrician-Gynecologists

Study Objective: To determine current measures used by Canadian obstetrician-gynecologists (Ob/Gyns) to optimize patients undergoing myomectomy during the peri- and intra-operative periods, and to identify gaps in knowledge or barriers to access of blood conservation methods. Design: Survey. Setting: Full- or community- academic affiliated hospital. Patients: Patients undergoing myomectomies for benign disease performed by Canadian obstetrician gynecologists. Intervention: A self-administered electronic questionnaire was distributed to Canadian Ob/Gyns from September through December 2016. Measurements and Main Results: 68/120 (57%) completed responses were analyzed. Most respondents were general Ob/Gyn [72.1% (49) Ob/Gyn, 20.6% (14) Ob/Gyn-MIS, 4.4 % (3) MIS, 2.9% (2) GYN], who worked in the community [70.6% (48)] and practiced >10 years [67.7% (46)]. 79.4% (54) delay surgery to correct anemia. Most common preoperative medical agents used were: Tranexamic acid (94.1%), Ulipristal acetate (92.6%), GnRH agonist (79.4%), and Combined hormonal contraception (58.8%). Majority had access to hematology [83.8% (57)] and to IV iron [98.5% (67)], and have previously ordered IV iron before [82.4% (56)]. However, respondents had variable knowledge of oral and IV iron dosing and administration. Most common intra-operative agents used were: 94.1% (64) Vasopressin [subserosal (SS) 59.4% vs. intra-myometrial (IMM) 40.6%], 26.6% (17) Vasopressin with Epinephrine (SS 58.8% vs. IMM 41.2%), 73.5% (50) IV Tranexamic acid, 66.2% (45) Mechanical tourniquet, 33.8% (23) Misoprostol, 22.1% (15) Uterine artery ligation, 17.6% (12) Topical sealant, and 11.8% (8) Intra-op blood salvage. 52.9% (36) estimated 250–499 mL blood loss, <10% personal transfusion rate [73.5% (50)], but 69.1% (47) were uncertain of institutional transfusion rate. Conclusion: Most gynecologists delay surgery to correct anemia, but are uncertain of institutional transfusion rate, iron dosing and administration, and optimal peri-/intra-operative multi-modal approach for blood loss conservation. Education and creation of a clinical pathway to address uncertainty in measures to reduce bleeding can lead to decreased perioperative morbidity for myomectomy patients.

Two New Effective Tourniquets for Potential Use in the Military Environment: A Serving Soldier Study.

Limb tourniquets have been used extensively during modern Middle Eastern conflicts. Despite its undeniable successes, the combat applied tourniquet (C-A-T) has some shortfalls, principally its inability to reliably control lower limb bleeding when applied to the mid-thigh. We tested two tourniquets which may represent an improvement to the combat applied tourniquet; the tactical mechanical tourniquet and the tactical pneumatic tourniquet. We recruited 12 healthy service personnel and applied the tactical mechanical tourniquet and tactical pneumatic tourniquet to both lower limbs in a randomly generated sequence. Tourniquets were tightened until popliteal artery occlusion. This was measured via a SonoSite portable ultrasound machine by a single consultant vascular radiologist familiar with its use. A longitudinal view of the popliteal artery was obtained, and Doppler waveform monitored. The tourniquets were tightened around volunteers' mid-thigh by a second researcher accustomed with their use. Time to complete occlusion, number of windlass revolutions, and pain scores were collected by a third researcher. Non-normally distributed data are present as median (interquartile range). Ordinal nonparametric data are analysed by Mann-Whitney U testing. Participants had a median age of 32.5 (28-35). Both tourniquets demonstrated complete occlusion of the popliteal artery in all limbs (n = 24). The mechanical tourniquet achieved arterial occlusion after a median of 3.8 (3-4) turns, and 16 (12-20) seconds. No participants dropped out of the study because of intolerable pain, or any cause. Median pain scores for the mechanical tourniquets were 4.5 (3-7) (maximum pain) and 4.0 (2-7) (pain when locked). Median pain scores for the pneumatic tourniquet were 5 (2-6) (maximum pain) and 5 (2-6) (pain when fully applied). There was no statistical difference in maximum pain scores between the tactical mechanical tourniquet and the tactical pneumatic tourniquet (p = 0.75). No participant had any tourniquet applied for longer than 80 seconds. Both tourniquets completely occluded the popliteal artery in all participants within an acceptable pain threshold. Further testing is required before the presented tourniquets can be taken to the battlefield; particularly measures of self-application, and use on other anatomical areas.

Preliminary Comparison of New and Established Tactical Tourniquets in a Manikin Hemorrhage Model

Emergency tourniquet use has been associated with hemorrhage control and improved survival during the wars since 2001. The purpose of the present study is to compare the differential performance of two new tactical tourniquets with the standard-issue tourniquet to provide preliminary evidence to guide decisions on device development.A laboratory experiment was designed to test the effectiveness of tourniquets on a manikin thigh. Three models of tourniquets were assessed. The Rapid Application Tourniquet System (RATS) and the Tactical Mechanical Tourniquet (TMT) were compared with the standard-issue Combat Application Tourniquet(®) (C-A-T). Two users conducted 30 tests each.Percentages for effectiveness (hemorrhage control, yes/no) and distal pulse cessation did not differ significantly by model. When compared with the RATS, the C-A-T performed better (ρ < .001) for time to hemorrhage control and fluid loss. The C-A-T and TMT had comparable responses for most measures, but the C-A-T applied more pressure (ρ = .04) than did the TMT for hemorrhage control.All three tactical tourniquets showed substantial capacity for hemorrhage control. However, the two new tourniquet models (RATS and TMT) did not offer any improvement over the C-A-T, which is currently issued to military services. Indeed, one of the new models, the RATS, was inferior to the C-A-T in terms of speed of application and simulated loss of blood. Opportunities were detected for refinements in design of the two new tourniquets that may offer future improvements in their performance.

Rigid Junctional Tourniquet Effector Heads: Forces, Pressures, and Pressure Gradients Accompanying Target Artery Occlusion

Junctional tourniquets capable of controlling haemorrhage from distal sites are being actively developed for pre-hospital and emergency settings. One category of device uses a rigid mechanical effector head to occlude a target artery. It is important to minimize the forces, pressures, and pressure gradients used in order to avoid tissue and organ damage and to ensure subject comfort and safety. However, little is known about the magnitude of the forces and pressures necessary in order to affect artery occlusion with such devices. This work is a preliminary instrumental exploration of the pressure and force parameter space likely to arise when rigid mechanical tourniquet effector heads are used to occlude junctional arteries. Interface pressure data are measured for a commercially available system, namely the Combat Ready Clamp (CRoC), using biomedical interface pressure transducers (BIPTs) embedded in flexible low-profile pads sandwiched between the CRoC effector head and the target tissue site. Occlusion is produced in both iliac and femoral arteries at peak interface pressures in the range of 250–275 mmHg. A dynamometer is used to simultaneously measure the force applied to the actuator handle of improvised effector heads while also logging the interface pressure using either embedded or pad-based BIPT arrays. Measured forces in the range of 175–220 N and average interface pressures in the range of 250–310 mmHg are found to produce iliac and femoral artery occlusion using these improvised effector heads. Correct effector head location over a target artery can significantly reduce the forces required to affect occlusion. For instance, the force required to occlude the iliac artery using improvised effector heads is reduced from 175 to 110 N using an integrated Doppler probe to locate the target artery.

Practice of tourniquet use in Turkey: a pilot study.

The aim of the present pilot study was to evaluate patterns in the current practice of tourniquet use in Turkey. The results of this study can provide detailed information regarding tourniquet use and evaluate the need for guidelines on tourniquet use in Turkey. The questionnaire was sent to orthopedic residents and surgeons by either giving printed questionnaires directly or by establishing preliminary communication with surgeons and then sending questionnaires by e-mail. Participating staff consisted of 3 groups: Group 1: orthopedic surgeons; Group 2: orthopedic residents; and Group 3: orthopedic academic staff. Statistical differences in tourniquet use were analyzed among the groups. Use of mechanical tourniquet was significantly higher in Group 1. Plain cuffs were used in orthopedic surgical practice more frequently. Assistant and orthopedic theatre personnel were commonly reported by participants as the tourniquet applicant. Periodic educational practice was not routine. The number of reported complications was higher in Group 3. Cuff padding was generally routine practice. Scientifically valid options at lowest inflation pressure were not observed among the results at the expected rates. The results of this pilot study indicate that there is wide variation in some aspects of tourniquet practice in Turkey. The differences are not acceptable because of the potential for significant complications with some practices. There is a need to provide and ensure adequate education to provide the best patient care. Furthermore, protocols should be developed for acceptable standards of tourniquet use.

A single center retrospective review of hair tourniquet syndrome and a proposed treatment algorithm

IntroductionHair tourniquet syndrome (HTS) is a rare disorder characterized by a hair becoming tightly wound around an appendage. There is little known about the epidemiology, optimal treatment, or indications for surgical intervention in HTS. We hypothesized that HTS could be readily diagnosed and treated in the pediatric emergency department and we sought out factors predictive of surgical intervention. MethodsWe performed a single center retrospective review of all patients who presented with a hair tourniquet from May 2004 till March 2014. ResultsEighty-one patients were diagnosed with HTS, ranging in age from 2weeks to 22years. Of these patients, 69 were located on the toes, 5 on fingers, and 7 on genitalia. The average ages for each location were statistically different (p<0.0001). Ninety-four percent of patients were successfully treated by nonoperative means. Cellulitis was found in two patients. Tissue necrosis occurred in one patient. ConclusionHTS is an uncommon disorder and location differs with age. Chemical depilatory agents should be a first line treatment for this condition in most patients. If chemical tourniquet release fails, then the patient should undergo mechanical tourniquet release. If edema, erythema and pain fail to resolve after tourniquet release, then persistent hair tourniquet should be investigated.

Preliminary uterine artery ligation versus pericervical mechanical tourniquet in reducing hemorrhage during abdominal myomectomy

Objective To compare the effectiveness of preliminary uterine artery ligation versus pericervical mechanical tourniquet in reducing hemorrhage during myomectomy. Methods A total of 103 patients undergoing myomectomy were randomly allocated to undergo preliminary uterine artery ligation (52 patients) or pericervical tourniquet (51 patients). The primary outcome measure was estimated blood loss. Secondary outcomes included duration of the operation, duration of hospital stay, postoperative hemoglobin, and the need for postoperative analgesia. Results Operative blood loss was significantly less with uterine artery ligation compared with tourniquet (433.80 ± 285.21 vs 823.23 ± 237.33 mL, P < 0.001). The mean duration of the operation was lower in the uterine artery ligation group compared with the tourniquet group (50.5 ± 8.7 vs 76.3 ± 9.4 minutes, P < 0.001). Postoperative hospital stay was significantly shorter in the uterine artery ligation group compared with the tourniquet group (4.1 ± 0.1 vs 5.1 ± 0.2 days; P < 0.001). Postoperative hemoglobin concentrations and the need for postoperative analgesia were higher in the uterine artery ligation group ( P = 0.012 and P < 0.001, respectively). Conclusion Uterine artery ligation was more effective than pericervical tourniquet as a preliminary step in reducing blood loss during abdominal myomectomy.