title: Tourniquet cuff pressure and nerve injury in knee arthroplasty in a bloodless field: a neurophysiological study.
abstract: OBJECTIVE
  Tourniquet-related nerve injuries remain a concern in orthopedic surgery. The cuff pressures used today are generally lower, and therefore a decreasing incidence of peripheral nerve injuries might also be expected. However, there have been few neurophysiological studies describing the outcome after bloodless field surgery. We describe the results of neurophysiological examinations and report the incidence of nerve injuries after total knee arthroplasty (TKA) in a bloodless field.
  
  
  METHODS
  This study was part of a prospective, randomized controlled clinical trial in patients scheduled for TKA in a bloodless field. 20 consecutive patients were enrolled. Electroneurography (ENeG) and quantitative sensory testing (QST) of thermal thresholds were performed on day 3. These tests were repeated 2 months after surgery when electromyography (EMG) with a concentric-needle electrode was also performed.
  
  
  RESULTS
  The mean tourniquet cuff pressure was 237 (SD 33) mmHg. Electromyographic signs of denervation were found in 1 patient, who also had the highest cuff pressure in the study population (294 mmHg). The sensory nerve response amplitudes were lower in the operated leg on day 3; otherwise, the neurophysiological examinations showed no differences between the legs.
  
  
  CONCLUSIONS
  When low tourniquet cuff pressures are used the risk of nerve injury is minor.
authors.affiliation: Orthopedics Section, Department of Clinical Science and Education, Södersjukhuset, Sweden. charlotta.olivecrona@sodersjukhuset.se
authors.forename: Charlotta
authors.initials: C
authors.lastname: Olivecrona
authors.forename: Richard
authors.initials: R
authors.lastname: Blomfeldt
authors.forename: Sari
authors.initials: S
authors.lastname: Ponzer
authors.forename: Benjamin Ribalta
authors.initials: BR
authors.lastname: Stanford
authors.forename: Bengt Y
authors.initials: BY
authors.lastname: Nilsson
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D004576:Electromyography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D059348:Peripheral Nerve Injuries / Q000453:epidemiology / Q000209:etiology*; D010543:Peroneal Nerve / Q000293:injuries*; D011312:Pressure / Q000009:adverse effects*; D011446:Prospective Studies; D013979:Tibial Nerve / Q000293:injuries*; D014111:Tourniquets / Q000009:adverse effects*