Pneumatic tourniquets and LOP
Today, tourniquets are used in more than 15,000 surgical procedures per day, underscoring their essential role in modern medicine. Tourniquets are indispensable in surgery to achieve hemostasis by limiting blood flow to a limb. This is accomplished by applying circumferential pressure, which occludes both arterial and venous circulation, thereby creating a bloodless surgical field. This field is crucial for improving surgical precision and minimizing intraoperative blood loss, particularly in orthopedic and trauma surgery [Bogdan-2018].
A key concept in the modern use of tourniquets is limb occlusion pressure (LOP), which is the minimum pressure required to stop arterial blood flow distal to the cuff. The adoption of LOP has made it possible to reduce the pressures required for effective hemostasis, thereby minimizing the risk of complications such as nerve injury and tissue damage. Studies have shown that using LOP-based settings can significantly reduce tourniquet pressures compared with traditional methods, improving patient safety and surgical outcomes [Tuncali-2018]. This approach is supported by the Association of periOperative Registered Nurses (AORN), which recommends specific safety margins based on LOP measurements [McMillan-2015]. In addition, the clinically acceptable agreement between different LOP measurement methods supports broader clinical use of these techniques, further optimizing tourniquet application [Hughes-2021]. Using limb occlusion pressure (LOP) to determine the minimum effective pressure can significantly reduce the risk of complications [Kumar-2016].
Bogdan, Y., & Helfet, D. L. (2018). Use of Tourniquets in Limb Trauma Surgery. Orthopedic Clinics of North America, 49, 157-165. https://doi.org/10.1016/j.ocl.2017.11.004
Hughes, L., & McEwen, J. (2021). Investigation of clinically acceptable agreement between two methods of automatic measurement of limb occlusion pressure: a randomised trial. Research Open Access.
Kumar, K., Railton, C., & Tawfic, Q. (2016). Tourniquet application during anesthesia: “What do we need to know?” Journal of Anaesthesiology Clinical Pharmacology, 32(4), 424-430. DOI: 10.4103/0970-9185.168174
McMillan, T. E., Gardner, T., & Johnstone, A. J. (2020). Current concepts in tourniquet uses. Surgery (Oxford), 38(3), 139-142.
Tuncali, B., Boya, H., Kayhan, Z., & Arac, S. (2018). Tourniquet pressure settings based on limb occlusion pressure determination or arterial occlusion pressure estimation in total knee arthroplasty? Acta Orthopaedica et Traumatologica Turcica, 1017-995X.
https://doi.org/10.1016/j.aott.2018.04.001