Tourniquet Practice Among Orthopaedic Surgeons in Saudi Arabia

Abdulmalik B Albaker; Ismail Almogbil; Abdulaziz F Alkheraiji; Abdullah H Alshahrani; Sultan K Alharbi; Ghada F AlSwaji; Razan M Alotaibi; Alanoud Alrashidi

doi:10.7759/cureus.45828

Tourniquet Practice Among Orthopaedic Surgeons in Saudi Arabia

Cureus. 2023 Sep 23;15(9):e45828. doi: 10.7759/cureus.45828. eCollection 2023 Sep.

Authors

Abdulmalik B Albaker¹, Ismail Almogbil², Abdulaziz F Alkheraiji¹, Abdullah H Alshahrani³, Sultan K Alharbi¹, Ghada F AlSwaji⁴, Razan M Alotaibi⁵, Alanoud Alrashidi⁶

Affiliations

¹ Department of Orthopaedics, College of Medicine, Majmaah University, Al Majma'ah, SAU.
² Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Buraydah, SAU.
³ Department of Orthopaedics, Unaizah College of Medicine and Medical Sciences, Qassim University, Buraydah, SAU.
⁴ Department of Orthopaedics, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU.
⁵ Department of Surgery, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU.
⁶ Department of Orthopaedics, King Fahad Medical City, Riyadh, SAU.

Abstract

Introduction This study aimed to evaluate the knowledge of tourniquet use among orthopedic surgeons in Saudi Arabia and assess the practical aspects of their use of tourniquets and the complications they have experienced in their practices. Materials and methods This cross-sectional study was conducted from December 2022 to February 2023. An online questionnaire was distributed among orthopedic surgeons and trainees in Saudi Arabia, and the surgeons' knowledge of tourniquet use was assessed using 17 questions. To investigate tourniquet usage, the participants were divided into three groups: orthopedic residents, specialists, and consultants. An upper limb cuff pressure (CP) of 200 mmHg and a lower limb CP of 250 mmHg were chosen as the cut-off values, and the doctors' choices were compared against literature recommendations using these measures. Result A total of 205 participants filled out the questionnaires; 130 residents, 15 consultants, and 60 specialists, with more males (175/205) than females responding. One hundred and twenty-one surgeons placed the cuff on patients by themselves, while 50 (24.3%) surgeons asked nurses for aid; 135 (65.6%) of them work in teaching hospitals, while 50 (24.3%) work in community hospitals. The incidence of post-tourniquet syndrome was unrelated to expertise (p=0.12). Conclusion When applied properly, tourniquets prevent excessive bleeding and keep the operative field clean during limb surgeries. This study aims to inspire the orthopedic community to reconsider long-held practices, especially regarding tourniquet pressure. The addition of ligature safety education to orthopedics training and outlining the settings and procedures for applying pressure should also be considered. The orthopedic community should set CP and process criteria to avoid complications. This study showed the importance of modifying the training of orthopedic residents to raise awareness and prevent unpleasant events from occurring.

Keywords: cuff pressure; limb occlusion pressure; orthopaedic resident; saudi arabia; tourniquet.