To Squeeze or Not to Squeeze: A District General Hospital Review of Knee Arthroscopy With and Without Tourniquet

Abstract

Background

Knee arthroscopy (KA) is a frequent technique used to treat knee joint problems across the world. Tourniquets are often utilised in KA; however, their safety is still debated. The aim of this study was to determine postoperative pain, recovery time, and postoperative surgery analgesia in patients undergoing KA with and without a tourniquet.

Methods

This prospective cohort study was carried out in the Orthopaedic Department of a district general hospital. A total of 28 patients undergoing KA were included and divided into two groups (14 tourniquet and 14 no-tourniquet). Pain, time for recovery, and use of opioid analgesia were recorded. Minimal clinically important difference (MCID) was also calculated to review the relevance of the difference in pain scores at different intervals.

Results

There were 23 (82.1%) males and five (17.9%) females from a total of 28. There was no significant difference (p=0.149) in mean ages of the patients in the tourniquet group (28.36±7.52 years) and the non-tourniquet group (29.57±5.61 years). The tourniquet group experienced a mean postoperative pain of 8.00±1.04 on the Visual Analog Scale, while the other group reported 8.21±0.89 (p<0.381). This reduced to 1.14±1.027 in the tourniquet and 0.29±0.469 in the non-tourniquet group (p=0.00) at six weeks' follow-up, thus indicating higher postoperative pain in the tourniquet group. This difference was also above the threshold for MCID, suggesting that it was clinically relevant and meaningful from a patient perspective, too. A greater requirement for postoperative surgery analgesia was also observed in the tourniquet group; however, the difference was not statistically significant.

Conclusion

Knee arthroscopy surgery without a tourniquet leads to lower pain and relatively lower analgesic demand postoperatively. Future studies should aim to include a large sample size and long-term functional outcomes for a better understanding of the topic.