Timing of Tourniquet Release: A Prospective Randomized Trial

BACKGROUND: Although the benefits and complications of tourniquet use are well-described, there has been minimal upper extremity research evaluating the timing of tourniquet release and how it affects patient outcomes. The objective of this study was to determine if tourniquet release prior to or after incision closure would affect clinical outcomes in a variety of upper extremity surgeries. METHODS: Two hundred fourteen consecutive patients were randomized into 2 groups: skin incision closure without releasing the tourniquet versus skin closure following tourniquet release. Demographic, intraoperative, and follow-up data were collected. Outcome measures included complications such as hematoma formation, Visual Analogue Scores for pain, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires. RESULTS: Two hundred fourteen patients were originally enrolled, with 172 available for follow-up. Ninety-one patients had the tourniquet released prior to incision closure and 81 patients had the tourniquet released after incision closure. Demographic data were similar between the 2 cohorts and there were no intraoperative or immediate postoperative complications requiring intervention in either group. In addition, follow-up data collected including visual analog scores and QuickDASH scores were similar between the 2 groups. CONCLUSIONS: In this prospective randomized trial, tourniquet release after surgical incision closure resulted in similar clinical outcomes at follow-up when compared with tourniquet release prior to incision closure. In addition, visual analog pain scores and QuickDASH scores were similar between these 2 groups. Surgeons may consider releasing the tourniquet either before or after incision closure when performing upper extremity surgery.