Postoperative Pain and Blood Loss of Non-use Compared to Partial-use of a Tourniquet in Bilateral Total Knee Replacement: A Randomized-Controlled Trial

Abstract

Objective: This study aimed to compare the effects of non-tourniquet usage (NTU) and partial-tourniquet usage (before osteotomy in operation; BOO) of a tourniquet in bilateral total knee arthroplasty (TKA) on postoperative pain and complications. Materials and Methods: A prospective randomized controlled trial with cross-over design was designed to compare the effect of NTU vs BOO in the patients underwent bilateral TKA. The opioid consumption and pain score were primary outcomes. Blood loss, the number of wound complications, the postoperative complications and time to ambulation were secondary outcomes. Results: NTU group showed a significantly reduction in opioid consumption (14.8 ± 8.3 mg) as compared to that of BOO group (24.6 ± 10.8 mg) in the postoperative 24 hours. The postoperative pain score was significantly lower by the first, second, third and fourth day postoperative in NTU group (3.2, 3.9, 3.5, 2.3) compared to BOO group (4.3, 5.6, 4.8, and 4.1). There was no significant difference in blood loss between the groups. Early postoperative wound ecchymosis was found in BOO group (5 knees), more than in the NTU group (1 knee) with statistical significance. Conclusion: Performing total knee arthroplasty (TKA) without using a tourniquet, can reduce particularly the magnitude difference in pain and opioid consumption better than using the tourniquet as well as lack of significant difference in blood loss. This will allow for future clinical implications to determine that NTU may be preferable due to reduced postoperative pain and fewer postoperative wound complications.