Efficacy of arterial occlusion pressure estimation-based tourniquet pressure settings in upper limb surgery

Background: The use of a minimal individualized effective pneumatic tourniquet pressure is recommended to avoid pressure related complications in extremity surgery. The aim of this study was to investigate the efficacy of arterial occlusion pressure estimation-based tourniquet pressure settings in upper limb surgery. Methods: Hundred and fifteen patients undergoing upper limb surgeries were enrolled in the present study. Arterial occlusion pressure estimation formula was used and a safety margin of 20 mmHg was added to arterial occlusion pressure in the tourniquet pressure setting. Primary and secondary endpoints were the amount of tourniquet pressure and its effectiveness respectively. Other outcome measures included the tourniquet pressure setting time and tourniquet related complications. Surgical team unaware of the tourniquet pressure assessed the bloodless surgical field. Results: The mean initial and maximal tourniquet pressures were 171.5 +/- 13.7 and 175.5 +/- 13.2 mmHg, respectively. The effectiveness of the tourniquet was rated as "excellent" and "good" in the initial and middle stages, and at the end of the surgery of the procedure in 97.3%, 99.1%, and 100% of cases respectively. The mean tourniquet pressure setting time was 29.0 +/- 3.7 s. No tourniquet related complications were observed. Conclusions: Arterial occlusion pressure estimation-based tourniquet pressure setting is a practical and effective method, which allows using lower tourniquet pressures than previously used in the literature for upper extremity surgery. (C) 2021 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.