195. MINIMIZING TOURNIQUET PRESSURE IN PAEDIATRIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTIVE SURGERY: A BLINDED, PROSPECTIVE RANDOMISED CONTROLLED TRIAL

Abstract

Purpose: Tourniquet cuff pressures in paediatric patients are commonly set at standard pressures. Recent evidence on adult subjects has shown that safer and more effective cuff pressures can be achieved by measuring limb occlusion pressure (LOP) and using a wide, contour cuff. There is little evidence validating these techniques in children. The primary objective of this study was to evaluate if a difference in tourniquet cuff pressure can be achieved in a paediatric population using a wide contour cuff in conjunction with measured LOP when compared to a standard cuff and pressure.

Method: Subjects aged 10 to 17 years that underwent anterior cruciate ligament repair were included and ran-domised into either the control group or the experimental ‘LOP’ group using variable block randomisation. The tourniquet cuff was inflated to 300 mmHg in the control group or to the recommended tourniquet pressure based on LOP measurement in the LOP group. The surgeon was blinded to cuff selection, application and pressure throughout the surgical procedure. Immediately following the surgical procedure, the surgeon rated the quality of the bloodless field on a visual analogue scale (VAS). This study was powered as an effectiveness trial and intention to treat analysis was used.

Results: Following a planned interim analysis at midpoint, complete data was recorded for 11 patients (control group) and 10 patients (LOP group). The quality of the surgical field was not different between groups (p= 0.053). There was a statistically significant difference in mean cuff pressure between the control group (300 mmHg) and the LOP group (151 mmHg) (p < 0.001). We ran the same analysis comparing the LOP data to hypothetical control data of 250 mmHg and our results remained statistically significant (p < 0.001).

Conclusion: The use of an automatic LOP measurement with the use wide contour cuffs can significantly reduce average tourniquet cuff pressures in paediatric patients compared to typical practice of 300 mmHg or 250 mmHg without compromising the quality of the surgical field.