Tourniquet cuff pressure: The gulf between science and practice

Area of Science:

• Orthopaedic Surgery
• Surgical Techniques
• Patient Safety

Background:

• Tourniquet use is critical for achieving a bloodless surgical field in orthopaedic procedures.
• Minimizing tourniquet pressure is essential to reduce potential tissue microstructure and biochemical damage.
• Recommended pressures are 90-100 mm Hg above systolic BP for the thigh and 200 mm Hg for the arm.

Purpose of the Study:

• To survey orthopaedic surgeons regarding their routine tourniquet pressure settings.
• To assess surgeon awareness of and adherence to literature-based tourniquet pressure guidelines.
• To identify discrepancies between clinical practice and evidence-based recommendations for tourniquet application.

Main Methods:

• A website-based survey was distributed to a random sample of academic and community-based orthopaedic surgeons.
• Respondents reported their routinely used upper and lower extremity tourniquet pressures and literature awareness.
• Statistical analysis included Fisher's exact test and Mann-Whitney test to compare practice patterns.

Main Results:

• A total of 199 responses were collected; median lower extremity (LE) pressure was 300 mm Hg (range, 150-400), and upper extremity (UE) pressure was 250 mm Hg (range, 150-300).
• Less than 20% of surgeons used recommended LE pressures (≤250 mm Hg), and only 11.3% used recommended UE pressures (≤200 mm Hg).
• While 60% believed they were aware of supporting literature, only 25% (LE) and 11% (UE) used correct pressures, indicating a significant knowledge-practice gap.

Conclusions:

• A substantial disparity exists between current tourniquet pressure practices among orthopaedic surgeons and established evidence-based guidelines.
• Tourniquet application is not without risk; correct pressure usage is vital for minimizing patient morbidity.
• This survey underscores the need to raise awareness and promote evidence-based practice changes to improve patient outcomes.