Analisis metode deflasi torniquet langsung, bertahap, dan intermittent terhadap perubahan tekanan darah pada pasien operasi total knee arthroplasty
DOI: https://doi.org/10.33024/hjk.v19i9.1645
Metode Deflasi Tourniquet Pasien Total Knee Arthroplasty (TKA) Tekanan Darah
Abstract
Background: The use of an arterial tourniquet is common practice in total knee arthroplasty because it helps create a clearer surgical field. However, tourniquet release often triggers hemodynamic disturbances that can threaten patient stability. Although this issue has important clinical implications, there are currently no clear guidelines regarding the safest deflation technique.
Purpose: For the analysis of direct, gradual, and intermittent torquette deflation methods on blood pressure changes in total knee arthroplasty patients.
Method: This quasi-experimental study with a three-group pre-post design was conducted at the Central Surgical Installation of Dr. Soedono East Java Provincial General Hospital from June to September 2025. A total of 45 patients aged 50–85 years (15 per group), all normotensive and undergoing spinal anesthesia, were consecutively recruited. Blood pressure was recorded using a standardized observation sheet. Data analysis was performed using one-way ANOVA with planned follow-up.
Results: Initial systolic and diastolic blood pressures showed no differences between groups (systolic: F=1.002, p=0.369; diastolic: F=0.940, p=0.399). After deflation, the immediate deflation method produced a significantly greater decrease in blood pressure than either the stepwise or intermittent methods. Mean systolic blood pressures were 109.00 mmHg (immediate), 130.60 mmHg (stepwise), and 129.87 mmHg (intermittent) (F=26.639, p<0.001). Mean diastolic blood pressures were 73.33 mmHg, 79.87 mmHg, and 80.33 mmHg, respectively (F=5.513, p=0.007). No significant differences were found between the stepwise and intermittent methods in post-hoc tests.
Conclusion: A controlled tourniquet deflation approach, whether gradual or intermittent, is more effective in reducing the rate of hypotension after removal. Conversely, immediate deflation is more likely to cause a sharp drop in blood pressure. These results support the adoption of controlled deflation techniques as standard practice to improve perioperative stability and can serve as a basis for the development of institutional and national guidelines for safer tourniquet management.
Keywords: Blood Pressure; Tourniquet Deflation Method; Total Knee Arthroplasty (TKA) Patients.
Pendahuluan: Penggunaan tourniquet arteri merupakan praktik umum dalam tindakan total knee arthroplasty karena membantu menciptakan lapangan operasi yang lebih jelas. Namun, pelepasan tourniquet sering memicu gangguan hemodinamik yang dapat mengancam stabilitas pasien. Meskipun masalah ini memiliki implikasi klinis yang penting, hingga kini belum terdapat panduan yang jelas mengenai teknik deflasi yang paling aman.
Tujuan: Untuk analisis metode deflasi torniquet langsung, bertahap, dan intermittent terhadap perubahan tekanan darah pada pasien operasi total knee arthroplasty.
Metode: Penelitian quasi-eksperimental dengan desain tiga kelompok pre–post ini dilaksanakan di Instalasi Bedah Sentral Rumah Sakit Umum Daerah Provinsi Jawa Timur Dr. Soedono pada bulan Juni-September 2025. Sebanyak 45 pasien berusia 50–85 tahun (masing-masing 15 per kelompok), seluruhnya normotensif dan menjalani anestesi spinal, direkrut secara konsekutif. Tekanan darah dicatat menggunakan lembar observasi terstandar. Analisis data dilakukan menggunakan one-way ANOVA dengan uji lanjut terencana.
Hasil: Tekanan darah sistolik dan diastolik awal, tidak menunjukkan perbedaan antar kelompok (sistolik: F=1.002, p=0.369; diastolik: F=0.940, p=0.399). Setelah deflasi, metode deflasi segera menghasilkan penurunan tekanan darah yang secara signifikan lebih besar dibandingkan metode bertahap maupun intermittent. Rerata sistolik tercatat 109.00 mmHg (langsung), 130.60 mmHg (bertahap), dan 129,87 mmHg (intermiten) (F=26.639, p<0.001). Rerata diastolik masing-masing 73.33 mmHg, 79.87 mmHg, dan 80,33 mmHg (F=5.513, p=0.007). Tidak ditemukan perbedaan signifikan antara metode bertahap dan intermittent pada uji post-hoc.
Simpulan: Pendekatan deflasi tourniquet yang terkontrol, baik secara bertahap maupun intermittent lebih mampu mengurangi derajat hipotensi setelah pelepasan. Sebaliknya, deflasi langsung lebih berpotensi menimbulkan penurunan tekanan darah yang tajam. Hasil ini mendukung penerapan teknik deflasi terkontrol sebagai praktik standar untuk meningkatkan stabilitas perioperatif serta dapat menjadi dasar pengembangan pedoman institusional maupun nasional terkait manajemen tourniquet yang lebih aman.
Kata Kunci: Metode Deflasi Tourniquet; Pasien Total Knee Arthroplasty (TKA); Tekanan Darah.
Downloads
References
Almeida, M., De Sousa, E., & De Castro, R. (2019). Escalonated Tourniquet Deflation Strategy Reduces the Incidence of Hypotension After Total Knee Replacement Surgery: a Randomized Double-Blinded Controlled Trial. ARC Journal of Orthopedics, 4(1), 14–18.
Bala, M., Taxak, S., Bajaj, P., Chhikara, M., Ahlawat, M., & Zokarkar, A. (2023). Evaluation of Haemodynamic Changes in Patients undergoing Total Knee Arthroplasty under Regional Anaesthesia: A Prospective Observational Study. Journal of Clinical & Diagnostic Research, 17(10).
Chan, K., Jaibaji, R., Barker, E., Talwar, C., & Pang, C. (2025). A Systematic Review and Meta-Analysis of Tourniquet Pressures in Upper Limb Surgery. Journal of Clinical Medicine, 14(6), 1938.
Elbadrawy, R. E., & Aboelela, M. A. (2021). Gradual versus intermittent release of tourniquet in total knee arthroplasty surgery, effects on hemodynamics and acid base parameters: a prospective randomized controlled study. Egyptian Journal of Anaesthesia, 37(1), 234–240.
Govil, P., Kakar, P. N., Kapoor, A. K., Sharma, A., Govil, D., & Arora, D. (2008). Refractory Hypotension after Tourniquet Deflation in a Patient on Chronic Clomipramine Therapy. Indian Journal of Anaesthesia, 52(4), 443–447.
Harini, M., Pamuntjak, N. D., Suta, P. D. D., & Astuti, S. D. (2024). Prediksi Depresi Preoperatif Terhadap Terjadinya Nyeri Kronis pada Pasien Lansia Pasca Operasi Total Knee Arthroplasty. eJournal Kedokteran Indonesia, 12(2), 193–193.
Huh, I. Y., Kim, D. Y., Lee, J. H., Shin, S. J., Cho, Y. W., & Park, S. E. (2012). Relation between preoperative autonomic function and blood pressure change after tourniquet deflation during total knee replacement arthroplasty. Korean Journal of Anesthesiology, 62(2), 154–160.
Johnsen, M., Havik, S., Husby, V. S., Winther, S. B., Foss, O. A., Husby, O. S., & Lian, Ø. B. (2024). The use of tourniquet in total knee arthroplasty does not impact the functional outcome: a randomised controlled study. Journal of Orthopaedic Surgery and Research, 19(1), 704.
Katzman, J. L., Sandoval, C. G., Roof, M. A., Rozell, J. C., Meftah, M., & Schwarzkopf, R. (2025). Does the use of a tourniquet influence five-year outcomes following total knee arthroplasty? The Journal of Arthroplasty, 40(7), S208–S213.
Kim, E., Cho, M. R., Byun, S. H., Lim, J. A., Chae, S., Choi, W. K., Kim, I., & Kim, J. (2021). Sympathetic predominance before tourniquet deflation is associated with a reduction in arterial blood pressure after tourniquet deflation during total knee arthroplasty. Physiological Research, 70(3), 401–412.
Laloo, R., Dewi, M., Gwilym, B. L., Richards, O. J., McLain, A. D., & Bosanquet, D. (2023). Tourniquet use for people with peripheral arterial disease undergoing major lower limb amputations. Cochrane Database of Systematic Reviews, (7).
Oh, M. S., Kim, J. Y., Kim, C. L., Koh, S. R., Jung, Y., Kim, N. Y., & Jeong, M. A. (2022). The Association between Two-Stage Tourniquet Application during Total Knee Replacement and Blood Loss: A Retrospective Cohort Study. Journal of Clinical Medicine, 11(6), 1682.
Philipopoulos, G. P., Sharareh, B., Ganesan, G., Tromberg, B. J., O'Sullivan, T. D., & Schwarzkopf, R. (2023). Characterizing tourniquet induced hemodynamics during total knee arthroplasty using diffuse optical spectroscopy. Journal of Orthopaedic Research, 41(1), 104–114.
Pranesh, E., Pugazhendhi, G., Kumar, V., & Shankaran, S. (2024). Comparative study of use of tourniquet application during cementation versus use of full-time tourniquet application during total knee arthroplasty. Journal of Population Therapeutics & Clinical Pharmacology, 30(17).
Rao, M., Mudakanagoudar, M., & Devaraj, D. B. (2023). Effects of cyclic vs. non-cyclic deflation of pneumatic arterial tourniquet on haemodynamic and arterial blood gases in lower limb surgery: A prospective randomized study. Journal of Krishna Institute of Medical Sciences, 12(4).
Seker, M., Aktas Yildirim, S., Ulugol, H., Gucyetmez, B., & Toraman, F. (2024). Cardiovascular Effects of Tourniquet Application with Cardiac Cycle Efficiency: A Prospective Observational Study. Journal of Clinical Medicine, 13(10), 2745.
Song, I., Kim, D. Y., & Kim, Y. J. (2012). The effect of tourniquet deflation on hemodynamics and regional cerebral oxygen saturation in aged patients undergoing total knee replacement surgery. Korean Journal of Anesthesiology, 63(5), 425.
Tan, Y. Y., Ang, K. X. M., Tun, M. H., & Loh, Y. J. (2024). Intermittent tourniquet compared to throughout tourniquet use during Total Knee Arthroplasty in patients with BMI ≥30: A retrospective cohort study. Journal of Orthopaedics, 54, 46–50.
Wang, C., Zhou, C., Qu, H., Yan, S., & Pan, Z. (2018). Comparison of tourniquet application only during cementation and long-duration tourniquet application in total knee arthroplasty: a meta-analysis. Journal of Orthopaedic Surgery and Research, 13(1), 216.
Wu, W., Cao, L., Sun, K., & Wang, H. (2025). Comparing different timings of tourniquet application in total knee arthroplasty: effects on postoperative pain and bone cement interface. Journal of Orthopaedic Surgery and Research, 20(1), 59.
Zhang, L., Ning, Y., Yang, C., & He, T. (2025). Limiting tourniquet use during total knee arthroplasty improves short-term postoperative outcomes in patients with hypertension. Frontiers in Surgery, 12, 1535662.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Holistik Jurnal Kesehatan
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
