Our Summary

This research paper looks at the use of pneumatic tourniquets in surgery, specifically for operations on the upper extremities (arms and hands). Tourniquets are devices used to control bleeding by completely stopping the blood flow to a particular area, and they are commonly used in surgery to keep the area clear of blood.

However, high tourniquet pressures can cause complications. The researchers carried out a study to see if lower pressures could be used effectively. They gradually reduced the pressure used in a series of 226 operations and found that this approach worked well, with the average pressure used being 187 mmHg and the tourniquet being in place for an average of 25 minutes.

The researchers found that the number of surgeries a patient had undergone and their body mass index were related to the tourniquet pressure needed. In only 4.5% of cases, there was unexpected bleeding, but this was not linked to the tourniquet pressure, patient characteristics, or details of the operation.

The researchers concluded that using lower tourniquet pressures can help avoid complications, and they recommend using pressures below 200 mmHg in most surgeries where a tourniquet is needed.

FAQs

  1. What is the purpose of using pneumatic tourniquets in hand surgery?
  2. Can lower tourniquet pressures be used effectively in hand surgery according to the research findings?
  3. What factors were found to be related to the tourniquet pressure needed during surgery?

Doctor’s Tip

A doctor may tell a patient undergoing hand surgery that using lower tourniquet pressures during the procedure can help reduce the risk of complications. It is important for patients to discuss any concerns or questions they may have with their doctor prior to surgery.

Suitable For

Patients who may be recommended hand surgery include those with conditions such as carpal tunnel syndrome, trigger finger, tendon injuries, arthritis, fractures, nerve damage, and other hand-related injuries or disorders. Additionally, patients who have been involved in accidents or trauma resulting in hand injuries may also require hand surgery. Hand surgery can help improve hand function, reduce pain, and restore mobility in patients with these conditions.

Timeline

Before hand surgery:

  1. Patient consults with a hand surgeon to discuss the need for surgery and the procedure involved.
  2. Preoperative evaluation and tests are conducted to ensure the patient is fit for surgery.
  3. Patient receives instructions on preoperative preparations, such as fasting and medication adjustments.
  4. Day of surgery, patient arrives at the hospital or surgical center and is prepped for the procedure.

After hand surgery:

  1. Patient wakes up in the recovery room with their hand bandaged and possibly in a splint.
  2. Pain medication is administered to manage postoperative pain.
  3. Physical therapy may be recommended to help regain hand function and strength.
  4. Follow-up appointments with the surgeon are scheduled to monitor healing and remove stitches.
  5. Patient gradually resumes normal activities and daily routines as instructed by the surgeon.
  6. Full recovery and return to normal hand function can take weeks to months, depending on the extent of the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hand surgery include:

  1. Will a pneumatic tourniquet be used during my surgery?
  2. What pressure will the tourniquet be set at during the procedure?
  3. How long will the tourniquet be in place during the surgery?
  4. Are there any potential complications associated with the use of a tourniquet?
  5. How will the tourniquet pressure be monitored and adjusted during the surgery?
  6. How will my individual characteristics, such as previous surgeries and body mass index, affect the tourniquet pressure needed?
  7. What steps will be taken to minimize the risk of unexpected bleeding during the surgery?
  8. Are there any alternative methods to using a tourniquet that could be considered for my procedure?
  9. How will the use of a tourniquet impact my recovery and rehabilitation process?
  10. What should I expect in terms of pain management and wound care following the surgery?

Reference

Authors: Othman S, Pistorio AL, Lopez S, Orengia A, Born MW. Journal: J Hand Surg Asian Pac Vol. 2021 Dec;26(4):654-659. doi: 10.1142/S2424835521500636. PMID: 34789106