Low tourniquet pressure has less impact on lower extremity nerve innervation: comparison of different tourniquet pressures used with intraoperative neuromonitoring with a randomized controlled study
Abstract Background We aimed to investigate the compression and ischemic effects of two different tourniquet pressures on tissues during surgery show a clinical difference. Methods Patients aged 18–65 years who underwent foot and ankle surgery and applied a tourniquet in a single center between Sept...
| Autores principales: | , , , , , |
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| Formato: | Artículo |
| Lenguaje: | English |
| Publicado: |
BMC
2024-10-01
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| Colección: | Journal of Orthopaedic Surgery and Research |
| Materias: | |
| Acceso en línea: | https://doi.org/10.1186/s13018-024-05176-y |
| _version_ | 1827045182885855232 |
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| author | Ahmet Müçteba Yıldırım Serkan Bayram Taha Kizilkurt Nur Canbolat Mehmet Barış Baslo Mehmet Aşik |
| author_facet | Ahmet Müçteba Yıldırım Serkan Bayram Taha Kizilkurt Nur Canbolat Mehmet Barış Baslo Mehmet Aşik |
| author_sort | Ahmet Müçteba Yıldırım |
| collection | DOAJ |
| description | Abstract Background We aimed to investigate the compression and ischemic effects of two different tourniquet pressures on tissues during surgery show a clinical difference. Methods Patients aged 18–65 years who underwent foot and ankle surgery and applied a tourniquet in a single center between September 2022 and November 2023 were included in this prospective randomized study. Accordingly, tourniquet pressures were applied as limb occlusion pressure (LOP) + 50 mmHg in group 1 (12 patients) and LOP + 100 mmHg in group 2 (12 patients). The time point at which the femoral nerve motor evoked potential (MEP) decreased by 50%, the time point at which the MEP decreased by 100% for all nerves (femoral, tibial, and deep peroneal), and the time point at which all responses returned after the tourniquet was deflated were identified as the time points for analysis. Results There were no differences in demographic data (age, body mass index, and sex) between the two groups. The mean tourniquet pressure was 191 ± 16 mmHg in Group 1 and 247 ± 21 mmHg in Group 2 (p < 0.001). A 50% decrease in the femoral nerve MEP value was observed at an average of 47 min in Group 1 and 34 min in Group 2 (p < 0.001). A complete loss of MEP responses for all nerves was observed at an average of 69 min in Group 1 and 56 min in Group 2. After the tourniquet was deflated, all MEP responses returned to baseline values at an average of 8.5 min in Group 1 and 12.6 min in Group 2 (p = 0.007). The results showed that lower limb nerve innervation was affected later and returned to normal earlier after deflation of the tourniquet in Group 1 (low tourniquet pressure group). Conclusions The innervations of the lower extremity nerves were affected later in the group in which low tourniquet pressure was applied (average 191 mmHg). Again, in this group (LOP + 50 mmHg), nerve conduction recovered an average of 10 min after deflation and four minutes earlier than in the high tourniquet pressure group. Level of evidence Level I, diagnostic study. Trial registration NCT05926154. |
| first_indexed | 2025-02-18T14:20:23Z |
| format | Article |
| id | doaj.art-1cb4639503a2473b95f4485a173f25f6 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2025-02-18T14:20:23Z |
| publishDate | 2024-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-1cb4639503a2473b95f4485a173f25f62024-10-28T08:45:56ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2024-10-0119111110.1186/s13018-024-05176-yLow tourniquet pressure has less impact on lower extremity nerve innervation: comparison of different tourniquet pressures used with intraoperative neuromonitoring with a randomized controlled studyAhmet Müçteba Yıldırım0Serkan Bayram1Taha Kizilkurt2Nur Canbolat3Mehmet Barış Baslo4Mehmet Aşik5Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul UniversityDepartment of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul UniversityDepartment of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul UniversityDepartment of Anesthesiology, Istanbul Faculty of Medicine, Istanbul UniversityDepartment of Neurology, Istanbul University Faculty of MedicineDepartment of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul UniversityAbstract Background We aimed to investigate the compression and ischemic effects of two different tourniquet pressures on tissues during surgery show a clinical difference. Methods Patients aged 18–65 years who underwent foot and ankle surgery and applied a tourniquet in a single center between September 2022 and November 2023 were included in this prospective randomized study. Accordingly, tourniquet pressures were applied as limb occlusion pressure (LOP) + 50 mmHg in group 1 (12 patients) and LOP + 100 mmHg in group 2 (12 patients). The time point at which the femoral nerve motor evoked potential (MEP) decreased by 50%, the time point at which the MEP decreased by 100% for all nerves (femoral, tibial, and deep peroneal), and the time point at which all responses returned after the tourniquet was deflated were identified as the time points for analysis. Results There were no differences in demographic data (age, body mass index, and sex) between the two groups. The mean tourniquet pressure was 191 ± 16 mmHg in Group 1 and 247 ± 21 mmHg in Group 2 (p < 0.001). A 50% decrease in the femoral nerve MEP value was observed at an average of 47 min in Group 1 and 34 min in Group 2 (p < 0.001). A complete loss of MEP responses for all nerves was observed at an average of 69 min in Group 1 and 56 min in Group 2. After the tourniquet was deflated, all MEP responses returned to baseline values at an average of 8.5 min in Group 1 and 12.6 min in Group 2 (p = 0.007). The results showed that lower limb nerve innervation was affected later and returned to normal earlier after deflation of the tourniquet in Group 1 (low tourniquet pressure group). Conclusions The innervations of the lower extremity nerves were affected later in the group in which low tourniquet pressure was applied (average 191 mmHg). Again, in this group (LOP + 50 mmHg), nerve conduction recovered an average of 10 min after deflation and four minutes earlier than in the high tourniquet pressure group. Level of evidence Level I, diagnostic study. Trial registration NCT05926154.https://doi.org/10.1186/s13018-024-05176-yTourniquetNerve injuryQuadriceps denervationNeuromonitoringQuadriceps tendon thickness |
| spellingShingle | Ahmet Müçteba Yıldırım Serkan Bayram Taha Kizilkurt Nur Canbolat Mehmet Barış Baslo Mehmet Aşik Low tourniquet pressure has less impact on lower extremity nerve innervation: comparison of different tourniquet pressures used with intraoperative neuromonitoring with a randomized controlled study Journal of Orthopaedic Surgery and Research Tourniquet Nerve injury Quadriceps denervation Neuromonitoring Quadriceps tendon thickness |
| title | Low tourniquet pressure has less impact on lower extremity nerve innervation: comparison of different tourniquet pressures used with intraoperative neuromonitoring with a randomized controlled study |
| title_full | Low tourniquet pressure has less impact on lower extremity nerve innervation: comparison of different tourniquet pressures used with intraoperative neuromonitoring with a randomized controlled study |
| title_fullStr | Low tourniquet pressure has less impact on lower extremity nerve innervation: comparison of different tourniquet pressures used with intraoperative neuromonitoring with a randomized controlled study |
| title_full_unstemmed | Low tourniquet pressure has less impact on lower extremity nerve innervation: comparison of different tourniquet pressures used with intraoperative neuromonitoring with a randomized controlled study |
| title_short | Low tourniquet pressure has less impact on lower extremity nerve innervation: comparison of different tourniquet pressures used with intraoperative neuromonitoring with a randomized controlled study |
| title_sort | low tourniquet pressure has less impact on lower extremity nerve innervation comparison of different tourniquet pressures used with intraoperative neuromonitoring with a randomized controlled study |
| topic | Tourniquet Nerve injury Quadriceps denervation Neuromonitoring Quadriceps tendon thickness |
| url | https://doi.org/10.1186/s13018-024-05176-y |
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