Individualized Tourniquet Pressure Ensures Surgical Field Quality and Reduces Postoperative Pain in Knee Arthroscopy: A Double-Blind Randomized Trial
H.O. Cardoso Filho, B.F. Do Nascimento, G.D.M. Andrade, R. Hohl, R.A.A.E. Oliveira, M. MarocoloObjective:
Fixed high cuff pressures in knee arthroscopy may increase muscle damage and postoperative pain. This study evaluated whether minimal effective individualized occlusion pressure (MEIOP) maintains surgical field quality while reducing postoperative pain and analgesic use compared with standard occlusion pressure (SOP).
Methods:
The study comprised two phases: 1) international survey of orthopedic surgeons (n=79) assessing tourniquet widths and inflation pressures during elective knee arthroscopy; 2) a prospective double-blind randomized trial comparing SOP (350 mmHg) with MEIOP (~230 mmHg; individualized occlusion pressure plus safety margin). Surgical field quality was assessed using a 3-point Likert scale. Pain intensity (10-cm VAS) was assessed at discharge (~6 h) and postoperative days 1, 3, 5, 7, and 15 as well as overall 15-day pain perception and analgesic consumption. Mixed ANOVA and Mann–Whitney tests were applied, and Cohen’s d effect sizes calculated.
Results:
Survey confirmed frequent reliance on fixed high pressures, most commonly 350 mmHg. In the trial, surgical field quality was excellent in 100% of cases in both SOP and lower pressure MEIOP group. Pain decreased over time with significant group-time interaction (p=0.022). MEIOP reduced pain at discharge (p=0.0127; d=1.14) and overall 15 days pain (p=0.0429; d=0.89). Qualitative analysis suggested lower non-opioid and opioid use with MEIOP.
Conclusion:
MEIOP preserved excellent visualization while reducing postoperative pain and analgesic burden, supporting patient-tailored tourniquet pressures in knee arthroscopy.