Tourniquet-Related Nerve Injury in Orthopedic Surgery: Comprehensive Review on Pathophysiology, Diagnosis, and Mitigation Strategies

Tourniquets are widely utilized in orthopedic surgery to maintain a bloodless field, improving operational precision and safety. Despite their benefits, the risk of tourniquet-related nerve injuries remains a significant concern. Experimental and clinical evidence suggests that while 2 hours of tourniquet use is considered generally safe, longer durations require careful management to minimize the prevalence of neurological complications. Nerve injury management can vary from conservative measures to surgical interventions, with nerve transfers recommended for upper extremity injuries and nerve grafts for lower extremity injuries. This manuscript explores the preventive strategies for tourniquet-related nerve injury, including proper application techniques, monitoring, and adherence to protocols, and proposes preventive strategies to minimize the occurrence of these complications.