The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis

Autor: Nicholas R. Parsons, Joyce Yeung, Muhamed M Farhan-Alanie, Peter Wall, Fatema Dhaif, Martin Underwood, Alex Trompeter, Andrew J. Metcalfe
Rok vydání: 2021
Předmět:
Zdroj: European Journal of Orthopaedic Surgery & Traumatology
ISSN: 1432-1068
1633-8065
DOI: 10.1007/s00590-021-02957-7
Popis: 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 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.
Databáze: OpenAIRE
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