Recommendations and Protocols for the Safe Use of Tourniquets in Upper- and Lower-Extremity Surgeries

The tourniquet (TNQ) interrupts blood flow to a given anatomical segment and has critical applications in orthopedic surgeries by providing a blood-free operating field. The risks and complications attributed to its use are increased pain, reperfusion injury, edema, deep venous thrombosis, and peripheral nerve injury. The main recommendations for TNQ use and to reduce the occurrence of complications include adequate limb padding; TNQ inflation to pressures of 50 mmHg and 100 mmHg above the perfusion pressure for the upper and lower limbs respectively; avoid TNQ use in children and patients with cachexia, lupus, and coagulopathy; avoid keeping the device inflated for more than 2 hours; and have a trained team alert to deflation, which is characterized by the possibility of bleeding, pulmonary embolism, and myonephropathic metabolic syndrome. The present update article summarizes the best evidence on TNQ use in orthopedic surgeries and proposes a protocol for its safe use.