It's a Bloody Mess
Surgeons who operate without a tourniquet – up to 34% of surgeries in some studies – do so to mitigate risks and potential harm, including venous thromboembolism (VTE), pain, nerve damage, and soft tissue trauma
Tourniquet use does not increase the risk of VTE
In a prospective, cohort study involving 16,000 patients who underwent total knee surgery, 77% of the surgeries were performed with a tourniquet and 33% without a tourniquet. The study found no significant difference between the two groups in terms of the occurrence of venous thromboembolism. Specifically, there were 52 cases of VTE (0.42%) in the tourniquet group compared to 25 cases (0.67%) in the no-tourniquet group. The p-value for the cumulative 90-day incidence of VTE was 0.06.
Personalized tourniquet pressure may be a better choice
Optimization of tourniquet pressure is based on systolic blood pressure and limb occlusion pressure (LOP). Using randomized controlled trials with either personalized pressures (PP) and uniform tourniquet (UT) pressures, authors found a similar bloodless field and better patient-reported outcome measures using a PP strategy.
Setting the tourniquet pressure
LOP means the lowest tourniquet pressure required to cease the arterial blood flow into the extremity distal to the cuff. LOP can be determined automatically or manually by slow cuff inflation to pulse cessation with diagnostic equipment. Modern tourniquet systems permit an automated LOP estimation through a probe incorporated in the tourniquet system itself.