Comparison of the systolic blood pressure and limb occlusion pressure methods in determining effective tourniquet pressure in upper limb surgeries

Abstract

The importance of a tourniquet to a surgeon cannot be over emphasised. Pneumatic tourniquet pressure is usually determined by systolic blood pressure (SBP), but a new emerging method, the limb occlusion pressure (LOP) appears more promising, especially in upper limb surgeries. We compare the effectiveness of the SBP and LOP methods in determining the tourniquet pressure in forearm bone surgeries. This study was a prospective comparative study involving 60 forearm bone surgeries conducted over a 1-year period with randomisation into two groups. Those whose tourniquet pressure was determined using the SBP method (Group A) and those whose pressure was determined using the LOP method (Group B). Data collected included the tourniquet pressure, tourniquet performance using a Likert scale as well as tourniquet-related complications were noted. Analysis was done with the Statistical Package for the Social Sciences (version 22 trademark of the International Business Machine) and Excel (version 13.0, Microsoft, Redmond, WA). There was a statistically significant difference in the mean tourniquet pressure between the two groups (SBP = 234.43 ± 11.87 mmHg; LOP = 199.17 ± 16.44 mmHg, P < 0.001). Both methods provided a satisfactory dry field throughout the tourniquet duration with no statistically significance difference in the tourniquet performance between the two groups. Although two cases of tourniquet-related nerve palsy were noted in the SBP group, it was not statistically significant (P = 0.355). The LOP method provided a satisfactory dry surgical field at a lower tourniquet pressure than the SBP method with no complications.