Evaluation of Ischemia and Reperfusion Interval With Neuromonitorization in Tourniquet Application

NCT ID: NCT05926154

Last Updated: 2023-07-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

24 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-01-01

Study Completion Date

2024-01-31

Brief Summary

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The goal of this clinical trial is to compare two differential tourniquet pressure in lower extremity surgery cases. The main questions it aims to answer are:

* What are the perioperative neurophysiological effects of ischemia and compression in the tissue under the tourniquet?
* Are the effects of two different tourniquet pressures on neuromonitoring significantly different?
* Can the ideal time of the reperfusion interval be evaluated by neuromonitoring?
* Are the effects of two different tourniquet pressures on the quadriceps denervation significantly different from each other? Participants meeting the inclusion criteria will be evaluated for parameters to be used preoperatively. It will be evaluated in the 1st day, 1st week and 1-month follow-ups in the postoperative period.

The investigators will compare two different tourniquet pressure ( Limb occlusion pressure +50 mmHg / + 100 mmHg) to see if it will be evaluated whether there is a significant difference in terms of quadriceps denervation, vas scores, total blood estimate volume loss, intraoperative MEP decrease, and recovery times, quadriceps tendon thickness, thigh circumfrences.

Detailed Description

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As a result of the power analysis for this study, the number of samples was determined as 24. The study was started after the approval of the ethics committee.

Participants who met the inclusion and exclusion criteria were randomized in terms of tourniquet pressure to be applied and divided into two groups. It was planned to evaluate quadriceps tendon thickness by USG and MRI, thigh circumference, VAS scores, CBC, and CK in blood samples in the preoperative period of all patients. It was planned to obtain parameters related to MEP by using intraoperative neuromonitorization during the surgery. In the postoperative period, all parameters that were evaluated preoperatively on the 1st day, 1st week, and 1st month were re-evaluated. Finally, EMG evaluation was planned for 1 month.

Conditions

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Quadriceps Muscle Atrophy Tourniquet EMG

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

SINGLE

Participants

Study Groups

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LOP + 50 mmHg

As a result of randomization, the surgical tourniquet pressure is 50 mmHg higher than the limb occlusion pressure. Limb occlusion pressure is calculated using the formulation by Graham: LOP = \[(Systolic Pressure - Diastolic Pressure)× (Limb Diameter) / 3 Cuff Width)\] + Diastolic Pressure

Group Type EXPERIMENTAL

Surgical tourniquet pressure selection

Intervention Type PROCEDURE

Limb occlusion pressure is calculated using the formulation by Graham: LOP = \[(Systolic Pressure - Diastolic Pressure)× (Limb Diameter) / 3 Cuff Width)\] + Diastolic Pressure. One group is LOP + 50 mm Hg and other one is LOP + 100 mmHg

LOP + 100 mmHg

As a result of randomization, the surgical tourniquet pressure is 100 mmHg higher than the limb occlusion pressure. Limb occlusion pressure is calculated using the formulation by Graham: LOP = \[(Systolic Pressure - Diastolic Pressure)× (Limb Diameter) / 3 Cuff Width)\] + Diastolic Pressure

Group Type EXPERIMENTAL

Surgical tourniquet pressure selection

Intervention Type PROCEDURE

Limb occlusion pressure is calculated using the formulation by Graham: LOP = \[(Systolic Pressure - Diastolic Pressure)× (Limb Diameter) / 3 Cuff Width)\] + Diastolic Pressure. One group is LOP + 50 mm Hg and other one is LOP + 100 mmHg

Interventions

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Surgical tourniquet pressure selection

Limb occlusion pressure is calculated using the formulation by Graham: LOP = \[(Systolic Pressure - Diastolic Pressure)× (Limb Diameter) / 3 Cuff Width)\] + Diastolic Pressure. One group is LOP + 50 mm Hg and other one is LOP + 100 mmHg

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Operation planning in the foot and ankle area

Exclusion Criteria

* Having a history of previous foot and ankle surgery,
* Having a history of previous knee surgery or spinal surgery,
* Diagnosis of diabetes mellitus,
* Having a known diagnosis of a disease affecting the peripheral nervous system (peripheral neuropathy, previous spinal surgery, stroke, etc.),
* Having a diagnosis of a disease affecting the known peripheral vascular system (Peripheral vascular disease, calcified popliteal artery, peripheral arterial bypass surgery, vasculitis, advanced chronic venous insufficiency),
* Having a disease that affects the ideal tourniquet application (Chronic Lymphedema, BMI\>35, Stage 3 and above chronic renal failure, uncontrollable hypertension),
* Having been diagnosed with a known coagulation disorder,
* History of pulmonary embolism or deep vein thrombosis.
* ASA score above 3
* Surgery time to be less than 80 minutes
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Istanbul University

OTHER

Sponsor Role lead

Responsible Party

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AHMET MUCTEBA YILDIRIM

Principal Investigator, MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Serkan BAYRAM, Ass. Prof.

Role: STUDY_DIRECTOR

Istanbul University Medicine Faculty Orthoapedic and Traumatology Department

Locations

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Department of Orthopaedics and Traumatology, Istanbul University, Istanbul, Turkey

Istanbul, Fatih-Topkapı, Turkey (Türkiye)

Site Status RECRUITING

Countries

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Turkey (Türkiye)

Central Contacts

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Ahmet Muçteba YILDIRIM, Asistant Dr

Role: CONTACT

090 534 303 8472

Facility Contacts

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Ahmet M YILDIRIM, Assistant

Role: primary

090 212 414 2000 ext. 31516

References

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Yildirim AM, Bayram S, Kizilkurt T, Canbolat N, Baslo MB, Asik M. Low tourniquet pressure has less impact on lower extremity nerve innervation: comparison of different tourniquet pressures used with intraoperative neuromonitoring with a randomized controlled study. J Orthop Surg Res. 2024 Oct 23;19(1):684. doi: 10.1186/s13018-024-05176-y.

Reference Type DERIVED
PMID: 39444003 (View on PubMed)

Other Identifiers

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Low Extremity neuromonitoring

Identifier Type: -

Identifier Source: org_study_id

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