Should Esmarch bandages be used for exsanguination in knee arthroscopy and knee replacement surgery? A prospective trial of Esmarch exsanguination versus simple elevation.

In order to compare the adequacy of exsanguination produced by Esmarch bandages with that produced by simple elevation for 2 min, a blind randomized prospective trial was undertaken in 50 patients undergoing total knee replacement surgery and 50 patients undergoing knee arthroscopy surgery. The mean blood loss during total knee replacement was significantly greater in the group exsanguinated by elevation (P < 0.01). The haematocrit of samples of the arthroscopy drainage fluid was consistently less than 1%, irrespective of the method of exsanguination used. None of the operating surgeons reported that they considered that either knee replacement surgery or arthroscopic knee surgery had been made any more difficult by the use of elevation as a means of exsanguination. In view of the established risks of using Esmarch bandages, we would suggest that the use of this method of exsanguination in these fields of orthopaedic surgery is not justified.