Efficacy of Bruner’s Rules in Decreasing Tourniquet Use Related Complications: A Prospective Study.

Abstract

Background: The pneumatic tourniquet is an efficient device used to achieve a surgical bloodless field, hence facilitating the surgeon during surgical procedures. However its use is not without risks as complications may occur. Studies have shown complication rate of 12.5% up to 60%. There are various recommendations and guidelines for its safe use to prevent the complications. Bruner’s rules published in 1996 have been shown to be efficient in decreasing tourniquet complications but they are not commonly used in our settings. Objectives: The aim of this study is to determine the efficacy of Bruner’s rules in decreasing tourniquet related complications in Rwanda.

Patients and methods: This prospective descriptive study was conducted between October 2018 and March 2019 at KFH and RMH and included participants aged 12-75 years who underwent UL and LL surgery with use of pneumatic tourniquet. Bruner’s rules were taught to surgeon/residents and used and we assessed the rate of tourniquet complications and functional recovery within 3 days post operation. We used multivariable analysis (Multiple logistic regressions) with the use of Chi-Square test.

Results: One hundred twenty six (126) patients were included in the study. Most patients were in the 26-45 years age group and were male. Complication rate was 3.1% (4 cases) and in 3 cases 2.38%) Bruner’s rules were not respected and in 1 case (0.79%) there was no identifiable cause; 3 cases had tourniquet pain and 1 had case of unexpected bleeding. Mean duration of tourniquet time in tourniquet pain cases was 136.7 mins (SD: +/- 15.3). Surgeon awareness of Bruner’s rules was 55%, surgeon satisfaction (bleeding control) was 99.2%. There was no case of sensorymotor deficit in postoperative. There was no correlation between complications and age, sex, site of surgery or type of surgery. There was strong correlation between complications and respect of Bruner’s rules, respect of duration of tourniquet application and between respect of Bruner’s rules and surgeon satisfaction.

Conclusion: Bruner’s rules are efficient in decreasing tourniquet complications, which will have significant impact on postoperative functional recovery. We recommend all Bruner’s rules to be applied and respected in all patients on whom the pneumatic tourniquet is used and need of education and teamwork of all theatre staff on Bruner’s rules.