Exploring Lower Tourniquet Pressures in Upper Extremity Surgery: A Randomized Controlled Trial

Area of Science:

• Orthopedic Surgery
• Vascular Surgery
• Anesthesiology

Background:

• Pneumatic tourniquets are standard in upper extremity surgery for a bloodless field, often set at 250 mm Hg.
• High tourniquet pressures can cause tissue damage and increased pain.
• Individualized pressure settings may improve safety and patient comfort.

Purpose of the Study:

• To evaluate the efficacy of tailoring tourniquet pressure to individual systolic blood pressure (SBP).
• To compare surgical field quality and patient pain using fixed vs. SBP-adjusted tourniquet pressures.
• To determine if SBP-based pressures reduce tourniquet inflation pressure.

Main Methods:

• Double-blinded, randomized controlled trial involving patients undergoing upper extremity surgery.
• Control group: fixed 250 mm Hg tourniquet pressure.
• Intervention group: SBP-based pressures (SBP <130 mm Hg + 60 mm Hg, 131-190 mm Hg + 80 mm Hg, >190 mm Hg + 100 mm Hg).
• Outcomes: intraoperative adjustments, surgical field quality, and tourniquet pain (VAS).

Main Results:

• Lower mean tourniquet pressure in the intervention group (192.81 mm Hg) vs. control (250 mm Hg).
• Comparable surgical field quality between groups (97.87% vs. 93.75%, p=0.56).
• Similar patient-reported pain scores (Intervention: 2.14 ± 2.34, Control: 1.60 ± 2.50, p=0.27).
• Rare tourniquet adjustments in the intervention group (2.13%).

Conclusions:

• SBP-based tourniquet pressure is effective for maintaining surgical visualization.
• This method achieves comparable results to fixed pressures at lower inflation levels.
• Findings support the adoption of SBP-tailored tourniquet pressures in upper extremity surgery.