# Recommendations and Protocols for the Safe Use of Tourniquets in Upper- and Lower-Extremity Surgeries

## TL;DR

This paper provides updated guidelines for safely using tourniquets in orthopedic surgeries to minimize complications like nerve injury and blood clots.

## Contribution

The paper offers a comprehensive protocol for tourniquet use based on the latest evidence to enhance surgical safety.

## Key findings

- Tourniquet inflation pressures should be 50 mmHg and 100 mmHg above perfusion pressure for upper and lower limbs, respectively.
- Avoid tourniquet use in children and patients with cachexia, lupus, and coagulopathy to reduce complications.
- Tourniquet inflation should not exceed 2 hours to prevent reperfusion injury and other risks.

## Abstract

The tourniquet (TNQ) interrupts blood flow to a given anatomical segment and has critical applications in orthopedic surgeries by providing a blood-free operating field. The risks and complications attributed to its use are increased pain, reperfusion injury, edema, deep venous thrombosis, and peripheral nerve injury. The main recommendations for TNQ use and to reduce the occurrence of complications include adequate limb padding; TNQ inflation to pressures of 50 mmHg and 100 mmHg above the perfusion pressure for the upper and lower limbs respectively; avoid TNQ use in children and patients with cachexia, lupus, and coagulopathy; avoid keeping the device inflated for more than 2 hours; and have a trained team alert to deflation, which is characterized by the possibility of bleeding, pulmonary embolism, and myonephropathic metabolic syndrome. The present update article summarizes the best evidence on TNQ use in orthopedic surgeries and proposes a protocol for its safe use.