Tourniquet-induced Nerve Ischemia

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Abstract
An inflated pneumatic tourniquet causes slowing in conduction velocity of the sciatic nerve. The amount of slowing and recovery time vary according to inflation pressure and to the duration of applied pressure. The conduction velocity always returned to normal provided the tourniquet was inflated for 2 h or less and pressures were < 500 mm Hg. The nerve directly under the tourniquet was most susceptible to injury. Inflation pressure should be as low as possible and determined according to systolic blood pressure. An Esmarch bandage should not be used as a pneumatic tourniquet because of its very small surface area. The cause of the nerve injury demonstrated is likely related to arterial ischemia. [A bloodless operative field is considered desirable for most surgical procedures on the upper and lower extremity. This is accomplished by using an Esmarch bandage or a pneumatic tourniquet.].

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