Tourniquet Use in Upper Limb Surgery

Abstract

Tourniquets are compressive devices that occlude venous and arterial blood flow to limbs and are commonly used in upper limb surgery. With the potential risk of complications, there is some debate as to whether tourniquets should continue to be routinely used. In this review, we first look at the different designs, principles, and practical considerations associated with the use of tourniquets in the upper limb. The modern pneumatic tourniquet has many design features that enhance its safety profile. Current literature suggests that the risk of tourniquet-related complications can be significantly reduced by selecting cuff inflation pressures based on the limb occlusion pressure, and by a better understanding of the actual level of pressure within the soft tissue, and the effects of cuff width and contour. The evidence behind tourniquet time, placement, and limb exsanguination is also discussed as well as special considerations in patients with diabetes mellitus, hypertension, vascular calcification, sickle cell disease and obesity. We also provide an evidence-based review of the variety of local and systemic complications that may arise from the use of upper limb tourniquets including pain, leakage, and nerve, muscle, and skin injuries. The evidence in the literature suggests that upper limb tourniquets are beneficial in promoting optimum surgical conditions and modern tourniquet use is associated with a low rate of adverse events. With the improvement in knowledge and technology, the incidence of adverse events should continue to decrease. We recommend the use of tourniquets in upper limb surgery where no contraindications exist.

Tourniquet application during anesthesia: “What we need to know?”

“…Surgical texts recommend cuff pressures of 200–300 mmHg for adults. Various methods have been implemented in an effort to lower effective cuff pressure:[78910111213]…”

“…Double tourniquet technique, to change the point of compression[7]Controlled hypotension to bring down systolic blood pressure can also be used to decrease direct cuff pressure against the tissue[8]Doppler technique and pulse oximetry to confirm the absence of the arterial pulse to determine the minimum inflation pressure[9]Tourniquet inflation based on limb occlusion pressure (LOP)[1011]Cuff pressure synchronization with systolic blood pressure. [111213]…”

“…Toxic metabolites produce pathophysiological changes when released into the general circulation. [10222324] The degree of these changes correlates with the duration of ischemia. All of these changes are fully reversed within 30 min of tourniquet deflation.…”

Uso da adrenalina com lidocaína em cirurgia da mão

“…4 Com o uso da adrenalina, temos como vantagens o início mais rápido e maior duração da anestesia, campo cirúrgico sem sangue mais duradouro, sem interrupç ões, e menor concentração de anestésico para atingir o controle da dor. 5 Isso permite a cirurgia com menor dosagem de sedativos e ainda facilita alguns procedimentos cirúrgicos, como tenólises e tenorrafias, e demonstra sua eficácia intraoperatoriamente.…”

The Effect of Different Regional Blocks: Combined Femoral-Sciatic, Spinal and Epidural Blocks on the Different Side Effects of Arterial Tourniquet in Patients Undergoing Lower Limb Orthopedic Surgeries —A Randomized Controlled Trail

“…However, it is important to appreciate their potential complications, e.g., tourniquet pain, limb ischemia, nerve injury and reperfusion injury, which may be minimized by understanding the proper technique of tourniquet, careful patient evaluation to exclude contraindications and by using modern pneumatic tourniquets which are designed to minimize the incidence of these potential complications [1].…”