JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS
AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
A&A International Anesthesia Research Society
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (7)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Horlocker, T. T.
Right arrow Articles by Schroeder, D. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Horlocker, T. T.
Right arrow Articles by Schroeder, D. R.
Related Collections
Right arrow Surgery
Right arrow Complications
Right arrow Regional Anesthesia

Anesth Analg 2006;102:950-955
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000194875.05587.7e

GENERAL ARTICLES

Anesthetic, Patient, and Surgical Risk Factors for Neurologic Complications After Prolonged Total Tourniquet Time During Total Knee Arthroplasty

Terese T. Horlocker, MD, James R. Hebl, MD, Bhargavi Gali, MD, Christopher J. Jankowski, MD, Christopher M. Burkle, MD, Daniel J. Berry, MD, Fernando A. Zepeda, MD, Susanna R. Stevens, BS, and Darrell R. Schroeder, MS

Departments of Anesthesiology, Orthopedic Surgery, and Health Sciences Research, Mayo Clinic, Rochester, Minnesota

Address correspondence and reprint requests to Terese T. Horlocker, MD, Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905. Address e-mail to horlocker.terese{at}mayo.edu.

Nerve injury after prolonged tourniquet inflation results from the combined effects of ischemia and mechanical trauma. Tourniquet release, allowing a reperfusion interval of 10–30 min followed by re-inflation, has been recommended to extend the duration of total tourniquet time. However, this practice has not been confirmed clinically. We retrospectively reviewed the medical records of 1001 patients undergoing 1166 primary or revision knee replacements with tourniquet time more than 120 min during a 5-yr interval. Mean total tourniquet time was 145 ± 25 min (range, 120–308 min). In 759 patients, the tourniquet inflation was uninterrupted. Two tourniquet inflations, interrupted by a single deflation, were noted in 371 patients, and 3 tourniquet inflations interrupted by 2 deflation intervals were noted in 23 patients. A total of 129 neurologic complications (peroneal and/or tibial nerve palsies) were noted in 90 patients for an overall incidence of 7.7%. Eighty-five cases involved the peroneal nerve and 44 cases involved the tibial nerve. In 39 cases, both peroneal and tibial deficits were noted. Complete neurologic recovery occurred in 76 (89%) peroneal and 44 (100%) tibial palsies. Postoperative neurologic dysfunction was associated with younger age (P < 0.001; odds ratio = 0.7 per 10-yr increase), longer tourniquet time (P < 0.001; odds ratio = 2.8 per 30-min increase), and preoperative flexion contracture >20° (P = 0.002; odds ratio = 3.9). In a subset of 116 patients with tourniquet times ≥180 min, longer duration of deflation was associated with a decreased frequency of neurologic complications (P = 0.048). We conclude that the likelihood of neurologic dysfunction increases with total tourniquet time and that a reperfusion interval only modestly decreases the risk of nerve injury.




This article has been cited by other articles:


Home page
 Contin Educ Anaesth Crit Care PainHome page
J. L. Deloughry and R. Griffiths
Arterial tourniquets
CEACCP, April 1, 2009; 9(2): 56 - 60.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
M. Carles, J. Dellamonica, J. Roux, D. Lena, J. Levraut, J. F. Pittet, P. Boileau, and M. Raucoules-Aime
Sevoflurane but not propofol increases interstitial glycolysis metabolites availability during tourniquet-induced ischaemia reperfusion
Br. J. Anaesth., January 1, 2008; 100(1): 29 - 35.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
B. Ben-David and A. Uskova
Tourniquet Injuries, Implied Causality, Babies, and Bathwater
Anesth. Analg., December 1, 2006; 103(6): 1593 - 1594.
[Full Text] [PDF]

Home page
 Anesth. Analg.Home page
J. R. Hebl and T. T. Horlocker
Tourniquet Injuries, Implied Causality, Babies, and Bathwater
Anesth. Analg., December 1, 2006; 103(6): 1594 - 1594.
[Full Text] [PDF]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.