Lower limb elevation: useful and effective technique of exsanguination prior to knee arthroscopy

The use of a Rhys-Davies (R-D) mechanical exsanguinator prior to the application of tourniquet is routine clinical practice in knee arthroscopy. However, this technique has been reported to cause injuries and is contraindicated in conditions like malignancy and latex allergy. Lower limb elevation alone has also been described as a technique of exsanguination. We conducted a prospective audit of two groups of patients (25 each) undergoing routine knee arthroscopy comparing the practice of mechanical exsanguination (R-D) with lower limb elevation technique. Average total operative times of the two groups were similar (R-D exsanguinator-23 min, limb elevation-21 min, n.s). Time interval between tourniquet inflation and skin incision was significantly lower in limb elevation technique (R-D exsanguinator-5 min, limb elevation-0.2 min, P < 0.001). Limb elevation technique of exsanguination helps avoid the risks associated with mechanical exsanguination and may potentially reduce the non-operative tourniquet application time.