Aflatooni Justin, Goble Haley, Lambert Bradley, Liberman Shari, McCulloch Patrick C
From the Houston Methodist Hospital, Houston Methodist Orthopedics and Sports Medicine, Houston, TX.
J Am Acad Orthop Surg Glob Res Rev. 2025 Apr 30;9(5). doi: 10.5435/JAAOSGlobal-D-24-00282. eCollection 2025 May 1.
Tourniquets are frequently used to minimize blood loss. Standard pressures (STPs) are typically higher than minimum limb occlusion pressure (LOP), which can contribute to postoperative pain among other complications. We sought to investigate the effect of STP versus LOP on postoperative pain and opioid medication use after anterior cruciate ligament reconstruction (ACLR).
Sixty patients (age = 37 ± 15 years) undergoing ACLR were recruited and randomized into STP (275 mm Hg; M = 15/F = 15) or LOP (180 ± 29 mm Hg; M = 15/F = 15) group. A photoplethysmography probe was used to determine appropriate tourniquet pressures for the LOP group. Tourniquet and surgical site pain (Visual Analog Scale scores 0 to 10), as well as opioid medication usage, was recorded for 14 days after surgery. A generalized linear mixed model was used to detect differences in pain and medication use over the 14 days. The type-I error was defined as = 0.05.
Tourniquet site pain was less in the LOP group during postoperative days (PODs) 1 to 5 (P < 0.05) and averaged across the two-week postoperative period (P = 0.015). Surgery site pain was less in the LOP group at PODs 9 and 14 (P < 0.05). Reduced opioid medication use was observed in the LOP group at PODs 3, 4, and 7 and averaged across the postoperative window (P < 0.05).
Individualized LOPs yield decreased postoperative pain and narcotic use compared with STP during ACLR.
止血带常用于减少失血。标准压力（STP）通常高于最小肢体阻断压力（LOP），这可能导致术后疼痛及其他并发症。我们旨在研究在进行前交叉韧带重建术（ACLR）后，STP与LOP对术后疼痛和阿片类药物使用的影响。
招募60例接受ACLR的患者（年龄 = 37 ± 15岁），随机分为STP组（275 mmHg；男性15例/女性15例）或LOP组（180 ± 29 mmHg；男性15例/女性15例）。使用光电容积脉搏波描记术探头为LOP组确定合适的止血带压力。记录术后14天的止血带及手术部位疼痛情况（视觉模拟评分0至10分）以及阿片类药物使用情况。采用广义线性混合模型检测14天内疼痛和药物使用的差异。I型错误定义为α = 0.05。
在术后第1至5天（PODs），LOP组的止血带部位疼痛较轻（P < 0.05），且在术后两周期间平均疼痛程度也较轻（P = 0.015）。在PODs 9和14时，LOP组的手术部位疼痛较轻（P < 0.05）。在PODs 3、4和7时，LOP组的阿片类药物使用量减少，且在术后观察期内平均使用量也减少（P < 0.05）。
与ACLR期间的STP相比，个体化的LOP可减少术后疼痛和麻醉药物使用。
