Effect of different cuff widths on the motor nerve conduction of the median nerve: an experimental study

Abstract

Background: A bloodless operative field is considered mandatory for most surgical procedures on the upper and lower extremity. This is accomplished by using either an Esmarch bandage or a pneumatic tourniquet, but a number of complications are associated with both. Nerve palsy is one of the most frequently encountered complications of this procedure. Wider cuffs have been found to cause reduced risk of tourniquet induced injury to the underlying soft tissues than the narrower ones due to the fact that lower occlusion pressures are caused by the former. To address and investigate this question, conduction in the median nerve has been measured proximal to tourniquet as well as distal to the tourniquet. Parameters of nerve conduction measured are nerve conduction velocity, latency and amplitude.

Nerve compression and pain in human volunteers with narrowvswide tourniquets

“…Contrary to Noordin's suggestions, narrow tourniquets can look back on a broad use in surgical settings in civilian hospitals and their safe use should not be reduced to military indications only [1,3,19] . Depending on the placement of the cuff, the occurrence of nerve related injuries has been experienced by 21%-28% of surgeons [5] .…”

“…In the current literature, the impact of the width of a tourniquet and as a consequence the pressure expansion, is discussed controversial [3,[10][11][12][13][14] .…”

“…A bloodless operative field is considered mandatory for most surgical procedures on the upper and lower extremity, allowing surgical procedures to be performed with improved precision, safety and speed [1][2][3][4][5][6][7] . The invention by McEwen in 1981, a modern microcomputer-based tourniquet system can be seen as a modified version of this basic idea of Cushing [2] .…”

“…Several studies related to tourniquet use have investigated various complications, the most frequent one being nerve palsy [1][2][3][4]6,8,9] . In the current literature, the impact of the width of a tourniquet and as a consequence the pressure expansion, is discussed controversial [3,[10][11][12][13][14] .…”

“…Nerve injury is a serious complication, associated with the clinical use of tourniquets, and influencing profoundly orthopedic surgery [1][2][3] . A bloodless operative field is considered mandatory for most surgical procedures on the upper and lower extremity, allowing surgical procedures to be performed with improved precision, safety and speed [1][2][3][4][5][6][7] .…”