Anesthesiological aspects of tourniquet use in orthopedic surgery: Advantages and disadvantages

A pneumatic cuff or tourniquet is a standard part of the operative procedure in orthopaedic surgery. Its role is to provide a bloodless surgical field, facilitate the surgeon's work, improve the visualisation and identification of anatomical structures, and reduce blood loss. Non-pneumatic and pneumatic cuffs are used in orthopaedics. The pressure in the pneumatic cuff should be 100mmHg above the patient's systolic blood pressure, and the highest allowed pressure is 300mmHg for a maximum of two hours. Local complications occur due to direct trauma, compression at the cuff placement site, or tissue ischemia distal to the cuff, while systemic ones arise as a result of reperfusion after inflation or deflation of the cuff. The most common local complications are skin damage, nerve damage, muscle damage with potential kidney failure, and blood vessel damage with the possibility of thrombosis. Systemic complications are observed in the form of changes in the respiratory, cardiovascular, urinary and central nervous systems and the occurrence of deep vein thrombosis of the lower extremities. Pain caused by tourniquets is one of the problems that anesthesiologists encounter in their daily work, which is difficult to regulate by administering analgesics and changing the depth of anaesthesia. Pain can persist for up to three weeks after surgery, making the patient's recovery difficult. The use of a tourniquet reduces intraoperative bleeding, and the thickness of the cement shell is greater, which achieves a better fixation of the implant to the bone.