Kirkley A, Rampersaud R, Griffin S, Amendola A, Litchfield
R, Fowler P. Tourniquet versus no tourniquet use in routine knee
arthroscopy: a prospective, double-blind, randomized clinical trial. Arthroscopy.
2000 Mar;16(2):121-6.
Question: In patients having knee arthroscopy, what
is the effect of tourniquet use on postoperative pain and functional
outcomes?
Design: Randomized (allocation concealed), double-blind, controlled
trial with 3-month follow-up.
Setting: University hospital in London, Ontario,
Canada.
Patients: Patients older than 16 years of age who
were scheduled for 1-hour knee arthroscopy. Exclusion criteria were
anterior cruciate or posterior cruciate ligament reconstructive
surgery, total synovectomy or meniscal suturing, evidence of neuromuscular
disease or systemic illness, or inability to read or write in English.
Of 145 patients enrolled, 120 (83%) (mean age, 43 years; 72% men)
met the inclusion criteria and completed the study.
Intervention: All patients had a pneumatic tourniquet
applied to the thigh of the operative leg and were allocated to the
tourniquet being inflated to 300 mm Hg (n = 61)
or not inflated (n = 59). General anesthesia was
used for all operations.
Main outcome measures: Oral narcotic use and pain
(measured by a 100-mm visual analog scale) for the first 5 postoperative days;
self-reported health status using the Western Ontario and McMaster
Universities Osteoarthritis Index (WOMAC); objective functional
outcome measured by the 6-minute walk test, 30-second stair climb,
and 1-leg standing vertical leap; isokinetic strength testing; and
time to return to work or sport. Health status and functional outcomes
were assessed at 2 and 6 weeks and at 3 months.
Results: The study had 80% power to detect a 25%
mean difference in WOMAC pain score. Mean WOMAC scores did not differ
between the groups (2 wk, P = 0.88; 6 wk, P =
0.93; 3 mo, P = 0.62). The average oral narcotic
use was 48.9 mg in the inflated tourniquet group and 49.1 mg in
the uninflated group. The groups did not differ for assessment of
postoperative pain (P = 0.24), except in patients
whose surgery lasted >30 minutes (n = 51) (greater
pain was reported by the inflated tourniquet group [P =
0.019]). The groups did not differ at any time point in objective
functional outcome measures or isokinetic strength testing, time
to return to work (18.2 d vs. 15.4 d, P = 0.61), or return to sport
(28.2 d vs. 20.9 d, P = 0.58). The surgeons, who were
blinded to tourniquet status, reported improved visibility and less
technical difficulty with the inflated tourniquet, but mean operative
time did not differ between the groups.
Conclusion: In patients having knee arthroscopy,
tourniquet use during the procedure did not affect postoperative
pain or functional outcomes.