The position of the tourniquet on the upper limb

Abstract

O ur aim was to determine if a tourniquet placed on the forearm has any advantage in clinical practice over the usual position on the upper arm. We randomised 50 patients who were undergoing an open operation for carpal tunnel syndrome under local anaesthesia into two groups. One had a tourniquet on the upper arm and the other on the forearm. The blood pressure, pulse, and level of pain were recorded at intervals of five minutes during the operation. The surgeons were also asked to evaluate the quality of the anaesthesia, the bloodless field, and the site of the tourniquet.The patients tolerated the tourniquet on the upper arm and forearm equally well. The surgeons had some difficulties when it was placed on the forearm. We therefore recommend placement of a tourniquet on the upper arm for operations on the hand and wrist which are carried out under local anaesthesia.

Tolerance of Upper Extremity Pneumatic Tourniquets and their Effect on Grip Strength

“…Firstly, the majority of hand procedures undertaken under local anaesthesia, such as carpal tunnel release, trigger finger release, etc., are more easily carried out under a tourniquet and can be carried out within this time duration (Edwards et al, 2000). Secondly, previous studies performed on healthy people have identified that 20 minutes of tourniquet application is the reported average tolerance duration of an upper arm tourniquet (Edwards et al, 2000; Maury and Roy, 2002; Odinsson and Finsen, 2002; Yousif et al, 1993). Our study confirmed that the majority of subjects tolerated the tourniquet relatively well for 21 minutes, as the mean VAS at this time was 5.3 of a maximum of 10.…”

The feasibility of using forearm intravenous regional anaesthesia instead of the standard upper arm technique in wrist and hand surgery

“…Conventional IVRA has become less popular because the possibility of accidental release of the tourniquet would add the life threatening risk of LAST [14] , which can be avoided by the use of smaller non-toxic doses of LA in FA-IVRA. However, the position of the tourniquet on FA may pose some difficulty to the surgeon when operating proximal to the wrist [15] . Regarding the comparison between NTG and fentanyl as adjuvants to lidocaine in IVRA, we couldn't find a single study comparing the effects of both agents.…”

Recommended Practices for the Use of the Pneumatic Tourniquet in the Perioperative Practice Setting

“…Lint from these materials can become embedded in the fasteners and reduce the effectiveness, possibly leading to an unexpected release of the cuff during the procedure. Tourniquet cuffs should be applied to the verified operative extremity in a location with adequate muscle mass to protect nerves and vessels. Upper arm and thigh tourniquets should be positioned on the limb at the point of maximum circumference proximal to the incision 18,19 Forearm tourniquets should be positioned mid‐forearm 18,19 …”

“… Upper arm and thigh tourniquets should be positioned on the limb at the point of maximum circumference proximal to the incision 18,19 Forearm tourniquets should be positioned mid‐forearm 18,19 Calf tourniquets should be placed with the proximal edge on the largest area of calf circumference 20 …”

“…Upper arm and thigh tourniquets should be positioned on the limb at the point of maximum circumference proximal to the incision 18,19 …”