Techniques of surgical tourniquet application in orthopaedic operations at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: A surgical tourniquet is an important instrument used in orthopaedic surgeries. It is applied on limbs to reduce blood supply to operation site thus provides the surgeon with a bloodless field, assisting in the clear visualisation of significant anatomical structures. Principles of tourniquet use exist but application is variable. Currently however, there are no guidelines in place governing the use of the tourniquet locally, predisposing patients to local and systemic complications, intra- and post-operatively. Objective: To describe the techniques of tourniquet application used in orthopaedic operations at MTRH. To describe the complications arising from use of the surgical tourniquet at MTRH. Methods: A descriptive prospective study conducted at Moi Teaching and Referral Hospital over a period of 6 months (March to August 2020). Eighty-six (86) patients who met inclusion criteria were recruited through convenience sampling technique. Cochran’s formula was used to determine the sample size. Patients were observed in three stages, and data was recorded in data collection sheet guided by a checklist designed and pretested by the researcher. Preoperatively, sociodemographic and clinical findings were recorded. Intraoperatively, techniques of tourniquet application and intraoperative complications were recorded. Postoperatively, complications were recorded. Data was analysed for these study variables using STATA version 16. Continuous variables such as age, tourniquet time and inflation pressures were summarised in form of ranges and medians. Categorical variables such as exsanguinations, skin protection, pressure determination methods, and complications were summarised inform of frequency distribution. Statistical tests were used to analyse associations between tourniquet application techniques and complications. Results: Males were 62 while females 24. Median age-34.0 (IQR: 27.0, 48.0) years. Clinical cases were mainly trauma (55.8%). Anaesthetics used (and number of procedures): general (29), regional (57). Limb procedures: upper (18), lower (68). Skin protective padding and exsanguinations by limb elevation were routinely done. Straight cuffs of different sizes were used. Inflation pressures (mmHg): upper limb (150-335), lower limb (300-350). Tourniquet pressure settings were mainly arbitrary (84.8%) and others (15.2%) were based on SBP. Tourniquet time (minutes): upper limbs (48-135), lower limbs (30-300). No breathing periods were used. Complications included tourniquet pain (45.4%), skin injury (24.5%), limb oedema (86.0%) and post tourniquet bleeding (39.5%). Conclusion: Various techniques were used in application of the tourniquet during orthopaedic operations. Complications were associated with the techniques of tourniquet application. Recommendations: Institutional guidelines should be established and be adhered to for the safe use of the tourniquet to prevent adverse effects. Further studies are recommended on comparisons between different tourniquet pressures and associated complications.