Limb occlusion pressure adjusted tourniquet use results in adequate hemostasis in pediatric limb surgeries: a prospective clinical study

Tourniquets are widely used in pediatric orthopedic surgeries to provide a bloodless operative field. However, inappropriate application can lead to complications. This study evaluates the efficacy and safety of using Doppler-derived limb occlusion pressure (LOP) to guide tourniquet pressure in children. A prospective observational study was conducted from November 2022 to February 2025 in a tertiary care orthopedic department. Pediatric patients (age: 1–15 years) undergoing upper or lower limb surgery were included. Tourniquet pressure was set at LOP + 50 mmHg, measured using a handheld Doppler. The primary outcome was adequacy of hemostasis; tourniquet-related complications were also recorded. The study included 122 patients (135 limbs), with a mean age of 8 years. Mean LOP was 111.4 ± 18.8 mmHg; mean tourniquet pressure was 161.7 ± 19.3 mmHg. Adequate hemostasis (Likert scale ≥ 3) was achieved in 95.55% of procedures. A strong linear correlation was observed between systolic blood pressure and tourniquet pressure tourniquet pressure = (0.90 × systolic blood pressure) + 77 mmHg; P < 0.001. No tourniquet-related complications were observed. LOP-guided tourniquet application is safe and effective in pediatric limb surgeries, allowing significant reduction in pressure compared to adult population.