Effect Of Tourniquet Research Articles

The use of tourniquet in total knee arthroplasty does not impact the functional outcome: a randomised controlled study

BackgroundThis study evaluates the clinical evidence for performing total knee arthroplasty (TKA) without a tourniquet, a shift from the near-universal use in 2009 to current trends towards tourniquet-less TKA in Norway and Sweden. This change is set against a backdrop of conflicting evidence regarding the positive and negative effects of tourniquet use.Questions/purposesThe aims were to determine if the tourniquet has an impact on [1] Forgotten Joint Score-12 (FJS-12) at 8 weeks after surgery; [2] postoperative strength and function; [3] postoperative pain and opioid analgesic use; and [4] operative time, bleeding, and length of stay (LOS).MethodsEighty-one patients were randomised to TKA with or without a tourniquet. The outcome measures, FJS-12, muscle strength, functional test, pain, estimated blood loss, haemoglobin (Hb) loss, knee circumference, opioid consumption, and LOS were assessed preoperatively and at 1 day, 8 weeks, and 1 year after surgery.ResultsNo significant difference in FJS-12 scores was found between the two groups at postoperative 8 weeks. However, the tourniquet group showed statistically significant better knee extension strength at 8 weeks (p = 0.045). There were no differences in other outcomes, except for a greater decrease in haemoglobin levels (p = 0.02) and higher estimated perioperative blood loss (p < 0.001) in the no tourniquet group than the torniquet group.ConclusionsOur study indicates that tourniquet use during TKA causes no significant differences in FJS-12 at 8 weeks, significantly reduces bleeding and postoperative Hb loss, and improves quadriceps strength at 8 weeks.Trial registrationClinicaltrails.gov. Registry Number: NCT03666598. Registered 30 August 2018.

Tourniquet Effect on Patients Undergoing Total Knee Arthroplasty: A Single-Blind, Randomized Controlled Trial.

Tourniquet is applied in Total Knee Arthroplasty (TKA) to reduce intraoperative blood loss and improve view of surgical field. However, tourniquet use in TKA is still in dispute. Some researchers find that tourniquet may lead to extra side effects such as aggravated pain and limb swelling, while others consider that tourniquet has no significant adverse impact on clinical outcomes of TKA patients. This trial is conducted to evaluate tourniquet effect on TKA patients. A prospective, single-blind, randomized controlled trail is adopted with a sample size of 130 knees from August 2020 to February 2023. Patients undergoing TKA are randomly allocated to tourniquet group and non-tourniquet group. Outcomes including quadriceps thickness and stiffness, operation time, total blood loss, intraoperative blood loss, postoperative blood loss, transfusion rate, thigh circumference, knee and thigh VAS, D-Dimer and CRP level, knee function score, patient satisfaction, and complications are evaluated in this trial. Student's t-test, Mann-Whitney U test, Pearson's chi-square test, and Fisher's exact test are used in this study. No significant difference in demographic information and baseline outcomes were found (p > 0.05). Participants in the tourniquet group had significantly less total blood loss and intraoperative blood loss, more postoperative blood loss, and higher D-Dimer level on postoperative day 3 when compared with non-tourniquet group (p < 0.05). Other outcomes including quadriceps thickness and stiffness, operation time, postoperative blood loss, transfusion rate, thigh circumference, knee and thigh VAS, D-Dimer level on postoperative day 1, CRP level, knee function score, patient satisfaction, and complications showed no significant difference (p > 0.05). Tourniquet application can effectively reduce intraoperative blood loss and total blood loss, without significant side effects. Hence, we advocate the regular use of tourniquet in primary TKA.

COMBAT-C: COntrol of Major Bleeding by Application of Tourniquets over Clothing

IntroductionExternal bleeding is the leading cause of preventable trauma-related death. In certain circumstances, tourniquet application over clothing may be necessary. Therefore, the aim of this study was to assess the effectiveness of tourniquets over different clothing setups.MethodsThree windlass tourniquets (CAT, SAMXT, SOFTT-W) were applied over nine different clothing setups and without clothing on the Hapmed™ Tourniquet Trainer. We compared each tourniquet in each clothing setup to the tourniquet trainer that was not dressed, and we compared the three tourniquets within each clothing setup concerning blood loss, applied pressure and application time. Regression analysis of the effect of thickness, mean weight, mean deformation, application time, and applied pressure on blood loss was performed.ResultsAlthough blood loss was significantly greater in the CAT and SAMXT tourniquets when they were applied over leather motorcycle trousers, the overall findings showed that the clothing setups significantly reduced or did not affect blood loss. The mean blood loss was the lowest with CAT and the highest with SOFTT-W. The measured mean pressures were lower than 180 mmHg in four out of nine clothing setups with SOFTT-W, but CAT and SAMXT always exceeded this threshold. CAT had the fastest application time. Blood loss was significantly influenced by applied pressure and application time but was influenced to a far lesser degree by clothing parameters.ConclusionThe effects of the clothing setups were of little clinical relevance, except for leather motorcycle trousers. The effects of rugged protective equipment, e.g., hazard suits, are conceivable and need to be tested for specific garments with the tourniquet intended for use. No clothing parameter for predicting tourniquet effectiveness could be identified.

Inflating a thigh tourniquet anteriorly displaces the popliteal artery relative to the posterior tibial cortex: an in vivo magnetic resonance imaging study

Background Previous work has demonstrated that with increasing knee flexion angles, the popliteal artery is located further away from the posterior tibial cortex (PTC), thus offering a safer position for procedures about the knee. Prior studies did not, however, incorporate the use of a surgical thigh tourniquet, a device commonly used by orthopaedic surgeons. Thigh tourniquet effect on popliteal spatial anatomy will be assessed in this study. Methods Using 3 Tesla magnetic resonance imaging, 6 volunteer knees were evaluated in both full extension and 90 degrees (°) of flexion, with and without a thigh tourniquet inflated to 200 millimeters of mercury. Axial images at the level of the posterior cruciate ligament (PCL) tibial insertion were obtained. The distance of the popliteal artery from the PCL tibial insertion and the PTC at this level were calculated. Results Without a tourniquet, at 0° and 90° of flexion, the mean distance between the popliteal artery and the PTC was 6.9 and 9.4 millimeters, respectively. With a tourniquet, at 0° and 90° the mean distance between the popliteal artery and the PTC decreased to 6.2 (-0.7) and 8 (-1.4) millimeters, respectively. These reductions in distances with inflating the tourniquet were statistically significant (p&lt;0.05). The distance between the artery and the PCL attachment did not change with and without inflating the tourniquet. Conclusions Inflating a thigh tourniquet moves the popliteal artery approximately 1 millimeter (8.5 percent) anterior towards the PTC and has no effect on the relationship between the popliteal artery and PCL insertion.

Effect of ankle versus thigh tourniquets on post-operative pain in foot and ankle surgery.

Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss, improve visualization in the surgical field, and to potentially reduce surgical time. There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure, placement site, and duration of use. There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery. To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery. Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken. Intraoperative tourniquet duration, tourniquet pressure and site, and postoperative pain scores using Visual Analogue Score were collected in immediate recovery, at six hours and at 24 h post-op. Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure, duration, site, and pain scores using Pearson correlation coefficient. All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh. There was no correlation between the site of the tourniquet and pain scores in recovery, at six hours and after 24 h. There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op (r = 0.14, P = 0.04) but not at six or 24 h post-operatively. This study shows that there was no statistically significant correlation between tourniquet pressure, site and post-op pain in patients undergoing foot and ankle surgery. The choice of using a tourniquet is based on the surgeon's preference, with the goal of minimizing the duration of its application at the operative site.

Blood-conserving and therapeutic efficacy of intravenous tranexamic acid at different time points after primary total knee arthroplasty with tourniquet application: a randomised controlled trial

BackgroundThe use of a tourniquet in combination with tranexamic acid (TXA) not only ensures clear vision, reduces intraoperative blood loss and shortens operative time but also improves cement-bone inter-digitation in total knee arthroplasty (TKA). However, there is no proof whether the blood flow blocking effect of tourniquet affects the antifibrinolytic effect of TXA, and the optimal timing of TXA administration is still unclear. Therefore, this study aims to investigate the effect of the first dose of TXA administered intravenously before tourniquet compression and release in TKA on perioperative blood loss and therapeutic efficacy in patients.MethodsIn this double-blind trial, 90 patients undergoing primary TKA were randomised into 2 groups: Group A, patients received intravenous TXA 10 min before tourniquet compression (20 mg/kg) and 3, 6 and 24 h later (10 mg/kg), and Group B, patients were treated the same as those in Group A but received intravenous TXA before tourniquet release. The primary outcomes were changes in blood loss, haemoglobin and haematocrit. Secondary outcomes included operation and tourniquet times, blood transfusion rate, subcutaneous petechiae and circumferential changes in the operated limb, visual analogue scale (VAS) score, hospital for special surgery (HSS) score, length of stay (LOS) postoperatively, complications and patient satisfaction.ResultsNo statistically significant difference was found between the 2 groups with regard to age, sex, weight, body mass index (BMI), Kellgren-Lawrence class, preoperative blood volume, preoperative laboratory values, operation and tourniquet times, transfusion rate, knee circumference, preoperative HSS, or VAS score (P:n.s.). There was no significant difference in intraoperative blood loss (IBL) (52.7 ml vs. 63.4 ml, P = 0.07), hidden blood loss (HBL) (91.4 ml vs. 119.9, P = 0.4) or total blood loss (TBL) (144.1 ml vs. 183.3 ml, P = 0.72) between Groups A and B. Haemoglobin, haematocrit and red blood cell count (RBC) dropped to a low point on postoperative day 3 and then rebounded, returning to normal levels on day 21, and the trend of change between the 2 groups was not statistically significant (P:n.s.). There was no significant difference in subcutaneous ecchymosis incidence, knee swelling rate, HSS score, VAS score, LOS postoperatively, complication rate or patient satisfaction (P:n.s.).ConclusionTXA was administered intravenously prior to tourniquet compression could effectively reduce blood loss in patients who had undergone total knee arthroplasty. However, there was no significant difference in knee swelling rate, subcutaneous bruising and petechiae incidence, knee function, complication rate or satisfaction between patients who TXA was given intravenously before tourniquet compression and release in primary TKA.

Acute Effect of KinesioTaping on Technical Skills of Wheelchair Basketball Players

The purpose of this research kinesiology taping (KT) is to increase the blood and lymph circulation under the skin and provide the athlete with a comfortable movement capacity. For this purpose, we aim to examine the effect of KT on the shoulder and supraspinatus muscles of wheelchair basketball players on the technical skills of athletes. Ten male wheelchair basketball players between the ages of 20 and 40 participated in the study. In the study, kinesiology tape was applied to the shoulder and supraspinatus muscle regions of the athletes. To evaluate the effect of KT regional shooting (2p), tourniquet, slalom, and sprint tests were applied before and after taping. SPSS 25 statistical program was used for the analysis of the data. The significance value for the analysis was accepted as 0.05. According to the research findings, it was determined that KT was effective in the 2nd, 3rd, and 4th regions in shooting from 5 regions, and KT was also effective in 20m sprint, right tourniquet throw, and slalom skills with and without the ball (p&amp;lt;0.05). We can say that KT affects shots made from positions that see the basket from the opposite and diagonal, increasing the dribbling skill and sprint performance. During the competition, it is recommended that the athletes do it on the shoulder and supraspinatus muscle areas.

Effects of tourniquet on surgical site wound infection and pain after total knee arthroplasty: A meta-analysis.

The application of a tourniquet (TNQ) for haemostasis in total knee arthroplasty (TKA) is controversial and lacking systematic evaluation. This meta-analysis assessed relevant international data to quantitatively evaluate the implications of using TNQ in TKA, further guide clinical diagnosis and treatment, and improve postoperative outcomes. A comprehensive computerised search of PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, VIP, and Wanfang databases was conducted to retrieve randomised controlled trials on the application of TNQ in TKA published from database inception to August 2023. The included data, ultimately comprising 1482 patients in 16 studies, were collated and subjected to meta-analysis using Stata 17.0 software. The results showed that the use of TNQ during TKA led to significantly higher rates of postoperative surgical site wound infection (3.96% vs. 1.79%, odds ratio: 2.15, 95% confidence intervals [CIs]: 1.11-4.16, p = 0.023) and wound pain scores on the first (standardised mean difference [SMD]: 0.65, 95% CI: 0.35-0.94, p < 0.001), second (SMD: 0.66, 95% CI: 0.01-1.31, p = 0.045), and third (SMD: 0.68, 95% CI: 0.31-1.05, pP < 0.001) day after the procedure. In conclusion, the application of TNQ in TKA increases the risk of postoperative surgical site wound infection and worsens short-term postoperative wound pain; therefore, TNQ should be used sparingly during TKA, or its use should be decided in conjunction with the relevant clinical indications and the surgeon's experience.

Effect of SAM junctional tourniquet on respiration when applied in the axilla: A swine model

PurposeSAM junctional tourniquet (SJT) has been applied to control junctional hemorrhage. However, there is limited information about its safety and efficacy when applied in the axilla. This study aims to investigate the effect of SJT on respiration when used in the axilla in a swine model. MethodsEighteen male Yorkshire swines, aged 6-month-old and weighing 55 – 72 kg, were randomized into 3 groups, with 6 in each. An axillary hemorrhage model was established by cutting a 2 mm transverse incision in the axillary artery. Hemorrhagic shock was induced by exsanguinating through the left carotid artery to achieve a controlled volume reduction of 30% of total blood volume. Vascular blocking bands were used to temporarily control axillary hemorrhage before SJT was applied. In Group I, the swine spontaneously breathed, while SJT was applied for 2 h with a pressure of 210 mmHg. In Group II, the swine were mechanically ventilated, and SJT was applied for the same duration and pressure as Group I. In Group III, the swine spontaneously breathed, but the axillary hemorrhage was controlled using vascular blocking bands without SJT compression. The amount of free blood loss was calculated in the axillary wound during the 2 h of hemostasis by SJT application or vascular blocking bands. After then, a temporary vascular shunt was performed in the 3 groups to achieve resuscitation. Pathophysiologic state of each swine was monitored for 1 h with an infusion of 400 mL of autologous whole blood and 500 mL of lactated ringer solution. Tb and T0 represent the time points before and immediate after the 30% volume-controlled hemorrhagic shock, respectively. T30, T60, T90 and T120, denote 30, 60, 90, and 120 min after T0 (hemostasis period), while T150, and T180 denote 150 and 180 min after T0 (resuscitation period). The mean arterial pressure and heart rate were monitored through the right carotid artery catheter. Blood samples were collected at each time point for the analysis of blood gas, complete cell count, serum chemistry, standard coagulation tests, etc., and thromboelastography was conducted subsequently. Movement of the left hemidiaphragm was measured by ultrasonography at Tb and T0 to assess respiration. Data were presented as mean ± standard deviation and analyzed using repeated measures of two-way analysis of variance with pairwise comparisons adjusted using the Bonferroni method. All statistical analyses were processed using GraphPad Prism software. ResultsCompared to Tb, a statistically significant increase in the left hemidiaphragm movement at T0 was observed in Groups I and II (both p < 0.001). In Group III, the left hemidiaphragm movement remained unchanged (p = 0.660). Compared to Group I, mechanical ventilation in Group II significantly alleviated the effect of SJT application on the left hemidiaphragm movement (p < 0.001). Blood pressure and heart rate rapidly increased at T0 in all three groups. Respiratory arrest suddenly occurred in Group I after T120, which required immediate manual respiratory assistance. PaO2 in Group I decreased significantly at T120, accompanied by an increase in PaCO2 (both p < 0.001 vs. Groups II and III). Other biochemical metabolic changes were similar among groups. However, in all 3 groups, lactate and potassium increased immediately after 1 min of resuscitation concurrent with a drop in pH. The swine in Group I exhibited the most severe hyperkalemia and metabolic acidosis. The coagulation function test did not show statistically significant differences among three groups at any time point. However, D-dimer levels showed a more than 16-fold increase from T120 to T180 in all groups. ConclusionIn the swine model, SJT is effective in controlling axillary hemorrhage during both spontaneous breathing and mechanical ventilation. Mechanical ventilation is found to alleviate the restrictive effect of SJT on thoracic movement without affecting hemostatic efficiency. Therefore, mechanical ventilation could be necessary before SJT removal.

Penile gangrene due to improper application of a condom catheter: a case report

BackgroundFournier’s gangrene is a rare, fulminant, and usually localized necrotizing soft tissue polymicrobial infection of the perineum, with occasional extension up to the abdominal wall.Case presentationWe describe an unusual case of penile gangrene in a 64-year-old Tunisian man suffering from urinary incontinence secondary to cerebrovascular accident. Gangrene developed due to continuous tourniquet effect on the penis caused by a condom catheter. Although source control was achieved with aggressive debridement, careful wound care, and wide-spectrum antibiotherapy, the patient died due to septic shock.ConclusionUse of condom catheters is not without complications. Careful placement, strict hygiene, and regular monitoring of the local condition are necessary.

Appendiceal Tourniquet, an extremely rare condition with an equally rare presentation: A case report and an integrative review

Small bowel obstruction is a common surgical emergency and needs timely intervention to prevent the development of complications. Acute appendicitis is a very rare, uncommon, and unnoticed cause of intestinal obstruction. Although functional obstruction due to paralytic ileus is common in acute appendicitis, mechanical obstruction is a fairly uncommon complication of this extremely prevalent disease. Furthermore, a normal appendix causing full-blown small bowel obstruction due to the tourniquet effect on the terminal ileum is exceptionally rare and the diagnosis is often overlooked. This work report on an extremely rare case of mechanical small bowel obstruction caused by a normal appendix forming tourniquet around an ileum loop. A 40-year-old male patient presented with clinical manifestations of small bowel obstruction, and the appendiceal tourniquet was discovered to be the cause during laparotomy. The patient was subjected to an appendectomy. The histopathological examination of the specimen reported normal appendiceal morphology. The case is unique in that it is the first report of a mechanical small bowel obstruction caused by an appendiceal tourniquet with normal histopathology.

Manual Compression of External Iliac Vein to Increase the Size of Femoral Vein for Femoral Central Venous Catheter Insertion in Small Children: Pilot Experimental Study and Randomized Trial

Highlights Abstract Aim: Pediatric femoral central venous catheter insertion is sometimes difficult due to small vein size. External iliac vein (EIV) compression may provide a tourniquet effect to the femoral vein (FV) and may facilitate catheterization. This study was conducted to determine the effect of EIV compression on FV size and femoral venous catheterization success rates. Methods: This study had 2 parts. The first part was a single-arm experimental study. The second part was a randomized controlled trial. Children weighing 2.5–15.0 kg were included. First part: All patients received the same intervention and measurements. FV anteroposterior and medial-lateral diameters were measured by ultrasound without EIV compression, after which EIV was compressed using the assistant’s finger, and FV diameters were measured. Second part: Patients were randomized into compression and control groups. The compression group received EIV compression during femoral venous catheterization. The control group did not receive the compression. Results: A total of 30 patients (15 in each group) participated. EIV compression significantly increased FV anteroposterior diameter (3.36 ± 1.01 mm with compression, 2.39 ± 0.76 mm without compression, mean difference = 0.97 mm, 95% CI = 0.73, 1.21, P &amp;lt; 0.001) and medial-lateral diameter (4.58 ± 1.40 mm with compression, 3.86 ± 1.32 mm without compression, mean difference = 0.72 mm, 95% CI = 0.43, 1.01, P &amp;lt; 0.001). Catheterization success rates were not different between groups. Conclusions: EIV compression increased FV size, but the effect on femoral venous catheterization success rates was inconclusive due to a small sample size.

Vascular injuries associated with total knee arthroplasty

&lt;div class="Section1"&gt;&lt;p class="abstract"&gt;Iatrogenic vascular injuries are rare but potentially devastating complications of total knee arthroplasty (TKA). This retrospective study analyzes vascular injuries associated with total knee arthroplasties in an urban, tertiary level referral hospital between 01 April 2010 to 31 March 2020 consisting of 6548 TKAs. Six patients sustained vascular injuries which included five primary, and one revision TKAs. Three patients were bilateral, and two were unilateral primary TKAs. The mean age-adjusted Charlson’s comorbidity index was two (range 1-3). Only two injuries were recognized intraoperatively. They underwent successful vascular repair. The third patient was diagnosed and underwent a vascular repair on the first postoperative day but experienced a permanent foot drop. Two other patients underwent thrombectomy on the fifth postoperative day; one required above-knee amputation, and the other continued to suffer from vascular claudication and paraesthesia. Another patient developed a pseudoaneurysm, which was identified and repaired five months after the primary TKA. The site of vascular injury was popliteal artery in five and superficial femoral artery in one patient. The mechanism of injury was a direct laceration in three, posterior Hohman's retractor in one, the effect of tourniquet on calcified vessels in one, and unknown in one patient. Early recognition was the only factor that significantly altered the functional outcome and limb salvage. Bilateral simultaneous total knee arthroplasties had no higher risks. A mandatory institutional protocol to recognize the early signs of vascular injuries is necessary for successful vascular repair.&lt;/p&gt;&lt;/div&gt;

The Effects of Pneumatic Tourniquet on Serum TAS, TOS, MDA and GSH Levels in Patients Undergoing Carpal Tunnel Syndrome Surgery

Bu çalışma karpal tünel sendromu cerrahisi uygulanan 25 hastada pnömotik turnike uygulamasının serum total oksidatif stres (TOS), total antioksidan kapasite (TAS), malondialdehit (MDA) ve glutatyon (GSH) düzeylerinde turnikenin farklı zamanlarında meydana gelen değişimlerin ortaya konulmasını amaçlamak için tasarlanmıştır. Çalışmaya karpal tünel sendromu tanısı alan ve cerrahi müdahale yapılan 25 hasta dahil edilmiş olup, hastalarının tamamında pnömotik turnike uygulandı. Hastalardan turnike uygulamasından 10 dakika önce, turnike uygulandıktan sonra 20. dakikada ve turnike açıldıktan 10 dakika sonra alınan kanlar 3500 rpm’de santrifüj edilerek serumları çıkarıldı. Elde edilen serumlardan TOS, TAS, MDA ve GSH düzeyleri kolorimetrik metodla spektrofotometrede bakıldı. Hastalardan elde edilen sonuçlar, turnike uygulamalarından sonra MDA ve TOS seviyelerinin yükseldiği, GSH ve TAS seviyelerinin azaldığını göstermiştir. Sonuç olarak, günümüzde sıklıkla görülen ve teşhisi konulmuş hastalara yaygın olarak yapılan karpal tünel sendromu ameliyatlarında cerrahi konforu artırmak amacıyla başvurulan turnike uygulamasına bağlı gelişen iskeminin ve turnike açıldıktan sonra gelişecek olan reperfüzyonun serum TOS, TAS, MDA ve GSH düzeyleri üzerinde nasıl bir değişim ortaya çıkardığı bu çalışma ile belirlenmiş olup, yapılacak olan çalışmalara katkı sunacaktır.

Effect of tourniquet on morphology and stiffness of quadriceps in patients receiving total knee arthroplasty: a randomized controlled trial

Objective: To evaluate tourniquet effect on the morphology and stiffness of quadriceps in patients receiving total knee arthroplasty (TKA). Methods: Total of 80 patients with primary knee osteoarthritis receiving unilateral primary TKA from August 2020 to June 2021 in Peking University Third Hospital were enrolled in this randomized controlled trial. The patients were randomly divided into tourniquet group and non-tourniquet group (40 cases in each group). The study measured and compared postoperative thickness and stiffness of quadriceps, as well as circumference of the affected thigh in two groups. Results: There were 11 males and 29 females in tourniquet group, 9 males and 31 females in non-tourniquet group, with mean age of (69.1±5.1) years and (67.4±5.3) years, respectively. There was no significant difference in demographic information such as gender, age and BMI (all P<0.05). Postoperative thickness of quadriceps, stiffness of quadriceps and circumference［x¯±s or M （Q1，Q3）］of the affected thigh in all patients were (2.76±0.69) cm, 25.20 (17.83, 32.90) m/s, 54.00 (51.13, 56.00) cm. These outcomes in tourniquet and non-tourniquet group［x¯±s or M （Q1，Q3）］were (2.78±0.76) cm and (2.73±0.61) cm, 24.00 (17.15, 33.13) m/s and 25.20 (18.68, 32.85) m/s, 54.00 (49.75, 55.00) cm and 54.50 (52.13, 57.53) cm, respectively; no significant deference was found in these indexes between the two groups (all P>0.05). Conclusion: Tourniquet has no significant effect on morphology and stiffness of quadriceps in patients undergoing TKA.

Inhibition of Na‐H exchanger 3 ameliorates lower limb ischemia/reperfusion‐induced acute kidney injury through preservation of mitochondrial biogenesis in mice

Despite advances in our understanding of acute kidney injury (AKI), its mortality rate remains high. Novel therapeutic targets are therefore needed. Mitochondrial dysfunction is a pivotal factor in the pathogenesis of AKI. The Na+‐H+ exchanger 3 (NHE3) plays a critical role in ATP‐dependent Na+ absorption in the proximal tubules. As such, inhibition of NHE3 may reduce metabolic demand for mitochondria thus reducing mitochondrial stress and dysfunction. In the present study, we sought to determine whether inhibition of NHE3 alleviated lower limb ischemia/reperfusion‐induced AKI. We induced lower limb ischemia/reperfusion by applying tourniquets bilaterally on the inguinal areas of male B6 or transgenic mice for 76 minutes followed by monitoring in metabolic cages for 22 hours. Control mice were treated in the same way except for no tourniquets. We used acetazolamide and kidney epithelial cell‐specific knockout to inhibit NHE3 in mice and monensin to mimic NHE3 in LLC‐PK1 cells. We assessed the renal function with urine output, transcutaneous GFR (tGFR) and serum urea nitrogen (SUN) and histology with H&amp;E staining. We measured mitochondrial biogenesis by mRNA levels of PGC‐1α, a master regulator of mitochondrial biogenesis, and its targeted genes NDUFS1 and ATP5o. Compared with the control, tourniquets reduced urinary output by 62%, tGFR by 95% and increased SUN by 774% in B6 mice. Acetazolamide, given by oral gavage (40 mg/kg), reduced NHE3 protein abundance by 37% in the kidney cortex of tourniquet‐injured mice, attenuated tourniquet‐induced reductions in urinary output by 100% and tGFR by 77%, and increase in SUN by 76%. It also attenuated tourniquet‐induced peritubular focal hemorrhage, tubular degeneration and nuclear condensation in the renal cortex. Tourniquets reduced mRNA levels of PGC‐1α, NDUFS1 and ATP5o by 45%, 44%, and 52%, respectively. Acetazolamide significantly blunted all these effects. Compared with no tourniquet‐injured mice, tourniquets reduced tGFR by 98% and increased SUN by 825% in the NHE3Flx/Flx mice, which served as a control for NHE3 knockouts. However, tourniquets only reduced tGFR by 25% and increased SUN by 105% in the kidney epithelial cell‐specific NHE3 knockouts. The difference in the effects of tourniquets between these two strains was significant (p&lt;0.05). Inhibition of NHE3 would reduce intracellular Na+concentrations. To determine whether intracellular Na+ regulates mitochondrial biogenesis, we treated LLC‐PK1 cells with monensin to raise intracellular Na+ levels. Monensin (10 μM) for 24 hours significantly reduced mRNA levels of PGC‐1α by 42%, NDUFS1 by 37% and ATP5o by 38% and activities of mitochondrial complex I by 100% and V by 58% in the cells. In conclusion, inhibition of NHE3 ameliorates tourniquet‐induced AKI through preservation of mitochondrial biogenesis, and this effect is most likely mediated by reducing intracellular Na+ concentration.

The effect of Aloe vera ethanolic extract in preventing ischemic-reperfusion injury during long bone fracture healing after tourniquet application: An animal study

Background: Tourniquet is a common instrument used in Orthopedics field to reduce blood loss, providing a better operating field. One of the deleterious effects of tourniquet is ischemic-reperfusion injury, which occurs after deflation of the tourniquet. One of the possible ways to mitigate ischemic-reperfusion injury is by administrating antioxidants to reduce oxidative stress. Natural ingredients like Aloe vera are well known for its antioxidant and anti-inflammatory activities. This experimental study was conducted by fracturing the tibia of male Wistar strain rats (Rattus norvegicus) and administering Aloe vera gel orally as antioxidant. Method: A total of 18 rats were used in this study, divided into 6 groups. The first group was the control group, that included rats with fractured tibia not receiving torniquet and aloe vera treatment. The second and third groups were rats with fracture, who received torniquet application for one hour and two hours respectively without aloe vera treatment. The rest were the treatment groups, the rats with factures were given different dosages of Aloe vera extract: 40 mg/kg bodyweight (BW), 60 mg/kg BW, and 80 mg/kg BW. Three hours after administration, the tourniquet was inflated for two hours, followed by its deflation. The tibia was harvested to examine levels of superoxide dismutase (SOD), Malondialdehyde (MDA), and Bone morphogenetic protein 7 (BMP-7), and callus diameter, and osteoblast numbers were evaluated. Result: Administration of Aloe vera extract reduced the oxidative stress parameters (SOD and MDA). Tourniquet application decreased the osteoblast cell count and callus diameter, and administration of Aloe vera extract increased both variables close to the control value (p&lt;0.05). Conclusion: The result of this study suggests that Aloe vera extract could be used to ameliorate ischemic-reperfusion injury.

Association of Use of Tourniquets During Total Knee Arthroplasty in the Elderly Patients With Post-operative Pain and Return to Function.

ObjectiveDuring total knee arthroplasty (TKA), tourniquet may negatively impact post-operative functional recovery. This study aimed at investigating the effects of tourniquet on pain and return to function.MethodsPubmed, Embase, and Cochrane Library were comprehensively searched for randomized controlled trials (RCTs) published up to February 15th, 2020. Search terms included; total knee arthroplasty, tourniquet, and randomized controlled trial. RCTs evaluating the efficacies of tourniquet during and after operation were selected. Two reviewers independently extracted the data. Effect estimates with 95% CIs were pooled using the random-effects model. Dichotomous data were calculated as relative risks (RR) with 95% confidence intervals (CI). Mean differences (MD) with 95% CI were used to measure the impact of consecutive results. Primary outcomes were the range of motion (ROM) and visual analog scale (VAS) pain scores.ResultsThirty-three RCTs involving a total of 2,393 patients were included in this study. The mean age is 65.58 years old. Compared to no tourniquet group, the use of a tourniquet resulted in suppressed ROM on the 3rd post-operative day [MD, −4.67; (95% CI, −8.00 to −1.35)] and the 1st post-operative month [MD, −3.18; (95% CI, −5.92 to −0.44)]. Pain increased significantly when using tourniquets on the third day after surgery [MD, 0.39; (95% CI, −0.19 to 0.59)]. Moreover, tourniquets can reduce intra-operative blood loss [MD, −127.67; (95% CI, −186.83 to −68.50)], shorter operation time [MD, −3.73; (95% CI, −5.98 to −1.48)], lower transfusion rate [RR, 0.85; (95% CI, 0.73–1.00)], higher superficial wound infection rates RR, 2.43; [(5% CI, 1.04–5.67)] and higher all complication rates [RR, 1.98; (95% CI, 1.22–3.22)].ConclusionModerate certainty evidence shows that the use of a tourniquet was associated with an increased risk of higher superficial wound infection rates and all complication rates. Therefore, the findings did not support the routine use of a tourniquet during TKA.

Місце кровоспинного джгута в сучасному алгоритмі тимчасової зупинки кровотечі на догоспітальному етапі

У статті проаналізовані показання і спірні моменти в алгоритмі тимчасової зупинки кровотечі на догоспітальному етапі за допомогою сучасних джгутів-турнікетів. У роботі надана коротка характеристика Combat Application Tourniquet, SWAT-Tourniquet як найбільш поширених джгутів. Табельний гумовий кровоспинний джгут має виражену шкідливу дію на тканини кінцівки і потребує вдосконалення або заміни. Профілактика турнікетного синдрому є важливим фактором у наданні екстреної медичної допомоги.

A retrospective investigation of the effect of tranexamic acid application and tourniquet duration on postoperative bleeding amount in patients undergoing total knee arthroplasty

Objectives: It is aimed to investigate the effect of tourniquet and tranexamic acid (TXA) on the amount of perioperative bleeding in patients undergoing total knee arthroplasty. Methods: One hundred and ninety-three patients included in the study. The patients included in the study were divided into 4 groups. Group 1 (n = 78) was determined as the patient group with long-term tourniquet application, but without additional application and was accepted as the control group. Group 2 (n = 40) was the long-term tourniquet and intravenous (IV) TXA applied group, Group 3 (n = 40) was the long-term tourniquet and intra-articular TXA applied group, and Group 4 (n = 35) was the short-term tourniquet (only in the cementing phase) and IV TXA applied group. The difference between groups according to use of a tourniquet during the operation, the method and dose of TXA, the amount of postoperative blood transfusion, the amount of drained blood, the length of hospital stay, and complications were investigated. Results: The largest Hemoglobin (Hb) and Hematocrit (Hct) decreases were found in Group 1 (3.39 ± 0.92 g/dl and 10.8%, respectively). Also the highest drainage (median 350 ml), transfusion (16.7%), length of hospital stay (mean 4.51 ± 1.07 days) and estimated blood loss (median 1559.8 ml) were in Group 1 (p &amp;lt; 0.05). The lowest Hb decrease (mean 2.95 ± 0.68 g/dl) and lowest drainage (median 150 ml) was seen in group 3 and the lowest length of hospital stay (mean 3.89 ± 0.8 days) in group 4 (p &amp;lt; 0.05). Conclusions: The use of TXA was shown to lead to a reduction in Hb and Hct, the amount of blood drained after surgery, and the length of hospital stay. The use of TXA may be a good option for bleeding control in patients undergoing total knee arthroplasty.