Tourniquet use has long allowed better visualization of structures allowing safe, precise, and efficient upper extremity surgeries.1-4
Many procedures can be done without a tourniquet using a wide awake, local anesthesia, no tourniquet [WALANT] technique. However, there are still some practice settings, patient characteristics, or procedural demands that necessitate the use of an upper extremity
tourniquet.5,6 Particularly in more distal upper extremity procedures, there can be a choice about where to place the tourniquet: on the upper arm or on the forearm.
A review of the current literature indicates that not only site but also laterality, pressure, duration, and padding have been questioned. Previous studies in healthy volunteers have indicated that the upper extremity side, tourniquet width, and tourniquet inflation pressure do not influence the amount of discomfort or duration of tourniquet inflation.7 In multiple clinical studies, the anatomic site—forearm or arm—has not been found to influence the patient's blood pressure, heart rate, or pain scores while undergoing a carpal tunnel release under local anesthesia.8-10 Trials with small numbers of healthy volunteers, now done decades in the past, have disparate results on forearm versus arm tourniquet placement in relation to patient comfort.10,11 One report in the anesthesia literature provides evidence that Bier blocks are better tolerated with forearm rather than arm tourniquet placement.12
The goal of this study was to evaluate tourniquet discomfort, both by visual analog scores [VAS] recorded at regular intervals and by the amount of time healthy participants tolerated an inflated tourniquet, in both the forearm and upper arm using modern equipment and currently used tourniquet pressures. Uncomfortable numbness and paresthesias are present after tourniquet deflation, and so this study also sought to understand the length of this discomfort after the tourniquet has been released from different anatomic sites. The hypothesis is that there would be no difference in tourniquet tolerance measured using VAS and inflation time between the forearm and arm sites. We further hypothesized that paresthesias would resolve in the same time-dependent manner after the tourniquet release from either site.
Methods
After Institutional Review Board approval, recruitment flyers were posted inviting study participation. Forty consecutive participants were enrolled. Patients saw the flyers when they came to the orthopaedic clinic for nonupper extremity issues. A standard script was used to describe the study after participants were screened. To be included, participants needed to have two well-perfused upper extremities and a normal basic screening neurovascular examination [