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

Abstract 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. 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: 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. 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). 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.