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The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis
PURPOSE: Tourniquet use in lower limb fracture surgery may reduce intra-operative bleeding, improve surgical field of view and reduce length of procedure. However, tourniquets may result in pain and the production of harmful metabolites cause complications or affect functional outcomes. This systema...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Paris
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233247/ https://www.ncbi.nlm.nih.gov/pubmed/33792771 http://dx.doi.org/10.1007/s00590-021-02957-7 |
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author | Farhan-Alanie, Muhamed M. Dhaif, Fatema Trompeter, Alex Underwood, Martin Yeung, Joyce Parsons, Nick Metcalfe, Andy Wall, Peter D. H. |
author_facet | Farhan-Alanie, Muhamed M. Dhaif, Fatema Trompeter, Alex Underwood, Martin Yeung, Joyce Parsons, Nick Metcalfe, Andy Wall, Peter D. H. |
author_sort | Farhan-Alanie, Muhamed M. |
collection | PubMed |
description | PURPOSE: Tourniquet use in lower limb fracture surgery may reduce intra-operative bleeding, improve surgical field of view and reduce length of procedure. However, tourniquets may result in pain and the production of harmful metabolites cause complications or affect functional outcomes. This systematic review aimed to compare outcomes following lower limb fracture surgery performed with or without tourniquet. METHODS: We searched databases for RCTs comparing lower limb fracture surgery performed with versus without tourniquet reporting on outcomes pain, physical function, health-related quality of life, complications, cognitive function, blood loss, length of stay, length of procedure, swelling, time to union, surgical field of view, volume of anaesthetic agent, biochemical markers of inflammation and injury, and electrolyte and acid–base balance. Random-effects meta-analysis was performed. PROSPERO ID CRD42020209310. RESULTS: Six RCTs enabled inclusion of 552 procedures. Pooled analysis demonstrated that tourniquet use reduced length of procedure by 6 minutes (95% CI −10.12 to −1.87; p < 0.010). We were unable to exclude increased harms from tourniquet use. Pooled analysis showed post-operative pain score was higher in tourniquet group by 12.88 on 100-point scale (95% CI −1.25–27.02; p = 0.070). Risk differences for wound infection, deep venous thrombosis and re-operation were 0.06 (95% CI −0.00–0.12; p = 0.070), 0.05 (95% CI −0.02–0.11; p = 0.150) and 0.03 (95% CI -0.03–0.09; p = 0.340). CONCLUSION: Tourniquet use was associated with a reduced length of procedure. It is possible that tourniquets also increase incidence of important complications, but the data are too sparse to draw firm conclusions. Methodological weaknesses of the included RCTs prevent any solid conclusions being drawn for outcomes investigated. Further studies are required to address these limitations. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00590-021-02957-7. |
format | Online Article Text |
id | pubmed-8233247 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Paris |
record_format | MEDLINE/PubMed |
spelling | pubmed-82332472021-07-09 The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis Farhan-Alanie, Muhamed M. Dhaif, Fatema Trompeter, Alex Underwood, Martin Yeung, Joyce Parsons, Nick Metcalfe, Andy Wall, Peter D. H. Eur J Orthop Surg Traumatol General Review PURPOSE: Tourniquet use in lower limb fracture surgery may reduce intra-operative bleeding, improve surgical field of view and reduce length of procedure. However, tourniquets may result in pain and the production of harmful metabolites cause complications or affect functional outcomes. This systematic review aimed to compare outcomes following lower limb fracture surgery performed with or without tourniquet. METHODS: We searched databases for RCTs comparing lower limb fracture surgery performed with versus without tourniquet reporting on outcomes pain, physical function, health-related quality of life, complications, cognitive function, blood loss, length of stay, length of procedure, swelling, time to union, surgical field of view, volume of anaesthetic agent, biochemical markers of inflammation and injury, and electrolyte and acid–base balance. Random-effects meta-analysis was performed. PROSPERO ID CRD42020209310. RESULTS: Six RCTs enabled inclusion of 552 procedures. Pooled analysis demonstrated that tourniquet use reduced length of procedure by 6 minutes (95% CI −10.12 to −1.87; p < 0.010). We were unable to exclude increased harms from tourniquet use. Pooled analysis showed post-operative pain score was higher in tourniquet group by 12.88 on 100-point scale (95% CI −1.25–27.02; p = 0.070). Risk differences for wound infection, deep venous thrombosis and re-operation were 0.06 (95% CI −0.00–0.12; p = 0.070), 0.05 (95% CI −0.02–0.11; p = 0.150) and 0.03 (95% CI -0.03–0.09; p = 0.340). CONCLUSION: Tourniquet use was associated with a reduced length of procedure. It is possible that tourniquets also increase incidence of important complications, but the data are too sparse to draw firm conclusions. Methodological weaknesses of the included RCTs prevent any solid conclusions being drawn for outcomes investigated. Further studies are required to address these limitations. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00590-021-02957-7. Springer Paris 2021-04-01 2021 /pmc/articles/PMC8233247/ /pubmed/33792771 http://dx.doi.org/10.1007/s00590-021-02957-7 Text en © Crown 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | General Review Farhan-Alanie, Muhamed M. Dhaif, Fatema Trompeter, Alex Underwood, Martin Yeung, Joyce Parsons, Nick Metcalfe, Andy Wall, Peter D. H. The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis |
title | The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis |
title_full | The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis |
title_fullStr | The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis |
title_full_unstemmed | The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis |
title_short | The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis |
title_sort | risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis |
topic | General Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233247/ https://www.ncbi.nlm.nih.gov/pubmed/33792771 http://dx.doi.org/10.1007/s00590-021-02957-7 |
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