Personalized tourniquet pressure versus uniform tourniquet pressure in trauma orthopedic surgery of extremities: a prospective randomized controlled study
Abstract Background Tourniquets are widely used in limb fracture surgeries. Controversies still exist about the pressure inflated, including unified tourniquet inflation pressure (UTIP) and personalized tourniquet inflation pressure (PTIP). This study evaluated the hemostatic effect between UTIP and...
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BMC
2024-11-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-024-05217-6 |
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| author | Tan Zhelun Sun Zhijian Mi er a li mu. Mu er ti zha Hou Jue Wang Zongrui Chen Chenghui Wu Xinbao Li Ting |
| author_facet | Tan Zhelun Sun Zhijian Mi er a li mu. Mu er ti zha Hou Jue Wang Zongrui Chen Chenghui Wu Xinbao Li Ting |
| author_sort | Tan Zhelun |
| collection | DOAJ |
| description | Abstract Background Tourniquets are widely used in limb fracture surgeries. Controversies still exist about the pressure inflated, including unified tourniquet inflation pressure (UTIP) and personalized tourniquet inflation pressure (PTIP). This study evaluated the hemostatic effect between UTIP and PTIP based on systolic blood pressure (SBP) in extremity fracture patients. Materials and methods Patients with fresh extremity fractures requiring tourniquets during surgeries were prospectively enrolled and randomly assigned to the UTIP and PTIP groups. The inflation pressure was set to 250 mmHg for the upper extremities and 300 mmHg for the lower extremities in the UTIP group and SBP plus 50 mmHg for the upper extremities and SBP plus 100 mmHg for the lower extremities in the PTIP group. The primary outcome was a hemostatic effect evaluated by the surgeon (satisfied or dissatisfied). Other secondary outcomes included postoperative changes in limb swelling and tourniquet-related complications. Results A total of 144 patients were enrolled and randomly assigned to the UTIP group or the PTIP group, and each group has 72 patients (36 upper limb and 36 lower limb). Totally, the hemostasis effect of the PTIP group was worse than that of the UTIP group by non-inferiority test. The hemostatic effect of upper limb fractures with SBP plus 50 mmHg for tourniquet inflation pressure was also worse than that with 250mmHg; however, there was no statistically significant difference between 300mmHg and SBP plus 100 mmHg in the lower limb group hemostasis effect due to a lack of power. Also, no difference was observed in the incidence of complications (p = 1.000) and postoperative changes in limb swelling during 2 days after surgery (upper limb: P1 = 0.546, P2 = 0.545; lower limb: P1 = 0.408, P2 = 0.857) between the PTIP and UTIP group. Conclusion In the surgery of limb fractures, setting SBP + 50mmHg as tourniquet pressure may not be sufficient for upper limbs. Also, we found no difference between the SBP + 100mmHg and the unified 300mmHg for lower limb surgeries. |
| format | Article |
| id | doaj-art-b6c3d3c9b55746a48e570a5b21f30a6d |
| institution | Kabale University |
| issn | 1749-799X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-b6c3d3c9b55746a48e570a5b21f30a6d2024-11-10T12:34:55ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2024-11-011911810.1186/s13018-024-05217-6Personalized tourniquet pressure versus uniform tourniquet pressure in trauma orthopedic surgery of extremities: a prospective randomized controlled studyTan Zhelun0Sun Zhijian1Mi er a li mu. Mu er ti zha2Hou Jue3Wang Zongrui4Chen Chenghui5Wu Xinbao6Li Ting7Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical UniversityDepartment of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical UniversityDepartment of Orthopedic, People’s Hospital Of Xinjiang Uygur Autonomous Region ChinaDepartment of Orthopaedics and Sport Medicine, Guangxi International Zhuang Medical HospitalDepartment of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical UniversityPeking University Health Science CenterDepartment of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical UniversityDepartment of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical UniversityAbstract Background Tourniquets are widely used in limb fracture surgeries. Controversies still exist about the pressure inflated, including unified tourniquet inflation pressure (UTIP) and personalized tourniquet inflation pressure (PTIP). This study evaluated the hemostatic effect between UTIP and PTIP based on systolic blood pressure (SBP) in extremity fracture patients. Materials and methods Patients with fresh extremity fractures requiring tourniquets during surgeries were prospectively enrolled and randomly assigned to the UTIP and PTIP groups. The inflation pressure was set to 250 mmHg for the upper extremities and 300 mmHg for the lower extremities in the UTIP group and SBP plus 50 mmHg for the upper extremities and SBP plus 100 mmHg for the lower extremities in the PTIP group. The primary outcome was a hemostatic effect evaluated by the surgeon (satisfied or dissatisfied). Other secondary outcomes included postoperative changes in limb swelling and tourniquet-related complications. Results A total of 144 patients were enrolled and randomly assigned to the UTIP group or the PTIP group, and each group has 72 patients (36 upper limb and 36 lower limb). Totally, the hemostasis effect of the PTIP group was worse than that of the UTIP group by non-inferiority test. The hemostatic effect of upper limb fractures with SBP plus 50 mmHg for tourniquet inflation pressure was also worse than that with 250mmHg; however, there was no statistically significant difference between 300mmHg and SBP plus 100 mmHg in the lower limb group hemostasis effect due to a lack of power. Also, no difference was observed in the incidence of complications (p = 1.000) and postoperative changes in limb swelling during 2 days after surgery (upper limb: P1 = 0.546, P2 = 0.545; lower limb: P1 = 0.408, P2 = 0.857) between the PTIP and UTIP group. Conclusion In the surgery of limb fractures, setting SBP + 50mmHg as tourniquet pressure may not be sufficient for upper limbs. Also, we found no difference between the SBP + 100mmHg and the unified 300mmHg for lower limb surgeries.https://doi.org/10.1186/s13018-024-05217-6TourniquetInflation pressurelimb fracturehemostatic effect |
| spellingShingle | Tan Zhelun Sun Zhijian Mi er a li mu. Mu er ti zha Hou Jue Wang Zongrui Chen Chenghui Wu Xinbao Li Ting Personalized tourniquet pressure versus uniform tourniquet pressure in trauma orthopedic surgery of extremities: a prospective randomized controlled study Journal of Orthopaedic Surgery and Research Tourniquet Inflation pressure limb fracture hemostatic effect |
| title | Personalized tourniquet pressure versus uniform tourniquet pressure in trauma orthopedic surgery of extremities: a prospective randomized controlled study |
| title_full | Personalized tourniquet pressure versus uniform tourniquet pressure in trauma orthopedic surgery of extremities: a prospective randomized controlled study |
| title_fullStr | Personalized tourniquet pressure versus uniform tourniquet pressure in trauma orthopedic surgery of extremities: a prospective randomized controlled study |
| title_full_unstemmed | Personalized tourniquet pressure versus uniform tourniquet pressure in trauma orthopedic surgery of extremities: a prospective randomized controlled study |
| title_short | Personalized tourniquet pressure versus uniform tourniquet pressure in trauma orthopedic surgery of extremities: a prospective randomized controlled study |
| title_sort | personalized tourniquet pressure versus uniform tourniquet pressure in trauma orthopedic surgery of extremities a prospective randomized controlled study |
| topic | Tourniquet Inflation pressure limb fracture hemostatic effect |
| url | https://doi.org/10.1186/s13018-024-05217-6 |
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