A systematic review of tourniquet use in paediatric orthopaedic surgery: can we extrapolate from adult guidelines?

Abstract

Tourniquets have traditionally been used in orthopaedic surgery to control bleeding and increase visibility in the intraoperative surgical field (1, 2, 3, 4). An increasing body of evidence has grown regarding the potential risks associated with their use. This is somewhat foreseeable given their mechanism of action: sustained circumferential pressure to occlude arterial flow resulting in reduced perfusion distal to the site of application. Laboratory research and studies in the adult population have shown that tourniquet use triggers changes in blood pressure and heart rate (5, 6), cerebral perfusion (7), coagulation (8, 9, 10), and core temperature (11). Local adverse effects include injury to muscle, blood vessels, nerves, and skin (2, 12, 13, 14, 15). Tourniquet use has also been associated with increased post-operative pain (16, 17, 18), longer length of hospital stay (16, 19), increased risk of wound infection and wound complications (19, 20), thromboembolic events (16, 18, 20), and compartment syndrome (16, 21). If not carefully sealed off, the accumulation of antiseptic surgical wash beneath the tourniquet during limb preparation can result in soft tissue damage and chemical burns (22).

Keywords

• pediatrics
• orthopedics
• tourniquets
• intraoperative care