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

Charlotta Olivecrona, Richard Blomfeldt, Sari Ponzer, Benjamin Ribalta Stanford, Bengt Y Nilsson, Charlotta Olivecrona, Richard Blomfeldt, Sari Ponzer, Benjamin Ribalta Stanford, Bengt Y Nilsson

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.

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.

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Source: PubMed

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