Should tourniquets be used in upper limb surgery? A systematic review and meta-analysis

This study compares the intra- and post-operative outcomes of upper limb orthopaedic surgical procedures performed with and without tourniquet assistance. A systematic review was undertaken assessing the electronic databases Medline, CINAHL, AMED and EMBASE. The evidence-base was critically appraised using the Cochrane Bone, Joint and Muscle Trauma Group quality assessment tool. Study heterogeneity was statistically tested using Chi2 and I2 statistics. Where appropriate a random-effects meta-analysis was undertaken to pool results of primary studies assessing mean difference of each outcome. Two studies investigating fifty-five patients undergoing upper limb surgery were identified. The limited findings suggest that the use of tourniquets may reduce the incidence of technical difficulties during upper limb surgery. It remains unclear whether the application of a tourniquet can influence pain perception or operative duration. The evidence-base was considerably limited in both size and methodological quality. Further study is recommended to address the literature's methodological weaknesses.