Exploring Lower Tourniquet Pressures in Upper Extremity Surgery: A Randomized Controlled Trial

Abstract

Background

Pneumatic tourniquets are routinely used in upper extremity surgery to create a bloodless operative field, often at a standard pressure of 250 mm Hg. However, high pressures may lead to complications, including tissue damage and increased pain. This study investigates whether tailoring tourniquet pressures to individual systolic blood pressure (SBP) can achieve comparable surgical field visualization while reducing inflation pressure.

Materials and Methods

This double-blinded, randomized controlled trial enrolled patients undergoing upper extremity surgery. The control group used fixed tourniquet pressures of 250 mm Hg, while the intervention group applied pressures based on SBP: <130 mm Hg → add 60 mm Hg, 131 to 190 mm Hg → add 80 mm Hg, >190 mm Hg → add 100 mm Hg. Outcomes included intraoperative tourniquet adjustments, surgeon-rated surgical field quality (1-excellent to 4-poor), and patient-reported tourniquet pain (visual analog scale). Data were analyzed using Fisher's exact tests and t-tests.

Results

Seventy-nine patients (control: 32, intervention: 47) were included. Mean tourniquet pressure was lower in the intervention group (192.81 ± 27.27 mm Hg) versus the control (250 mm Hg). Quality of the bloodless field was comparable (93.75% vs. 97.87%, p = 0.56), with no major complications. Pain scores were similar (control: 1.60 ± 2.50, intervention: 2.14 ± 2.34, p = 0.27). Tourniquet adjustments were rare (2.13%, intervention only).

Conclusion

SBP-based tourniquet pressures effectively maintain surgical field visualization at lower pressures without compromising safety or increasing pain. These findings support wider adoption of this method and warrant further large-scale studies.

Keywords

tourniquet pressure - upper extremity surgery - bloodless surgical field - systolic blood pressure - visual analog scale - randomized controlled trial

Ethical Approval

The study was approved by the NYU Langone Health Institutional Review Board (IRB) Research Ethics Committee (approval no. s21–00267) on May 18, 2021. All participants provided written informed consent prior to participating.

Patients' Consent

Written informed consent was obtained from a legally authorized representative for anonymized patient information to be published in this article.

Publication History

Received: 21 May 2025

Accepted: 21 July 2025

Article published online:
06 August 2025

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