Management of Tourniquet-Related Nerve Injury (TRNI): A Systematic Review

Tourniquet-related nerve injuries (TRNIs) are a rare but feared complication of operative tourniquet use. While the literature contains multiple discussions regarding tourniquet use as well as reported cases of its complications, there does not exist a consensus guideline for a safe tourniquet pressure, application time, or management of TRNI. This paper conducts a comprehensive review of the available literature for cases of TRNI with a specific focus on analyzing the management of cases of TRNI and their functional recovery. One hundred nine articles were retrieved in a search of medical literature (PubMed) using the keywords: tourniquet, nerve injury, paralysis, and palsy. The initial search was further narrowed down to seven case series and 10 case reports totaling 203 reported cases of TRNI. Of the 203 cases, 64 cases involved upper extremity tourniquet use, and 139 cases involved lower extremity tourniquet use. Most patients (89.75%) experienced a complete recovery. TRNI may occur over a wide range of tourniquet application times and tourniquet pressures; hence, it is a necessity for surgeons to consider it as a potential complication and understand the methodology for diagnosis and long-term management.