{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T23:00:07Z","timestamp":1785279607082,"version":"3.55.0"},"reference-count":17,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Wrist Surg"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Pneumatic tourniquets are routinely used in upper extremity surgery to create a bloodless operative field, often at a standard pressure of 250\u2009mm Hg. However, high pressures may lead to complications, including tissue damage and increased pain. This study investigates whether tailoring tourniquet pressures to individual systolic blood pressure (SBP) can achieve comparable surgical field visualization while reducing inflation pressure.<\/jats:p>\n                  <jats:p>This double-blinded, randomized controlled trial enrolled patients undergoing upper extremity surgery. The control group used fixed tourniquet pressures of 250\u2009mm Hg, while the intervention group applied pressures based on SBP: &lt;130\u2009mm Hg \u2192 add 60\u2009mm Hg, 131 to 190\u2009mm Hg \u2192 add 80\u2009mm Hg, &gt;190\u2009mm Hg \u2192 add 100\u2009mm Hg. Outcomes included intraoperative tourniquet adjustments, surgeon-rated surgical field quality (1-excellent to 4-poor), and patient-reported tourniquet pain (visual analog scale). Data were analyzed using Fisher's exact tests and t-tests.<\/jats:p>\n                  <jats:p>Seventy-nine patients (control: 32, intervention: 47) were included. Mean tourniquet pressure was lower in the intervention group (192.81\u2009\u00b1\u200927.27\u2009mm Hg) versus the control (250\u2009mm Hg). Quality of the bloodless field was comparable (93.75% vs. 97.87%, p\u2009=\u20090.56), with no major complications. Pain scores were similar (control: 1.60\u2009\u00b1\u20092.50, intervention: 2.14\u2009\u00b1\u20092.34, p\u2009=\u20090.27). Tourniquet adjustments were rare (2.13%, intervention only).<\/jats:p>\n                  <jats:p>SBP-based tourniquet pressures effectively maintain surgical field visualization at lower pressures without compromising safety or increasing pain. These findings support wider adoption of this method and warrant further large-scale studies.<\/jats:p>","DOI":"10.1055\/a-2662-1845","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T23:08:07Z","timestamp":1754521687000},"page":"380-385","source":"Crossref","is-referenced-by-count":0,"title":["Exploring Lower Tourniquet Pressures in Upper Extremity Surgery: A Randomized Controlled Trial"],"prefix":"10.1055","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4381-4656","authenticated-orcid":false,"given":"Gerardo E.","family":"Sanchez-Navarro","sequence":"additional","affiliation":[{"name":"Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, New York"},{"name":"Department of Medical Education, Universidad Central del Caribe, School of Medicine, Bayamon, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1268-7180","authenticated-orcid":false,"given":"Victoria","family":"Comunale","sequence":"additional","affiliation":[{"name":"Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jadie De","family":"Tolla","sequence":"additional","affiliation":[{"name":"Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0754-2262","authenticated-orcid":false,"given":"Walter","family":"Sobba","sequence":"additional","affiliation":[{"name":"Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6700-0107","authenticated-orcid":false,"given":"Jacques","family":"Hacquebord","sequence":"additional","affiliation":[{"name":"Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6786-2794","authenticated-orcid":false,"given":"Nader","family":"Paksima","sequence":"additional","affiliation":[{"name":"Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Azad","sequence":"additional","affiliation":[{"name":"Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, New York"},{"name":"Division of Hand Surgery, Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"424","DOI":"10.4103\/0970-9185.168174","article-title":"Tourniquet application during anesthesia: \u201cWhat we need to know?\u201d","volume":"32","author":"K Kumar","year":"2016","journal-title":"J Anaesthesiol Clin Pharmacol"},{"issue":"03","key":"ref2","first-page":"205","article-title":"Reducing tourniquet pressures in hand surgery: are lower pressures as effective?","volume":"12","author":"A Azad","year":"2022","journal-title":"J Wrist Surg"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1186\/s13018-023-04000-3","article-title":"Limb occlusion pressure versus standard tourniquet inflation pressure in minor hand surgery: a randomized controlled trial","volume":"18","author":"T Kanchanathepsak","year":"2023","journal-title":"J Orthop Surg Res"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.main.2015.01.005","article-title":"Evaluation of a new tourniquet for hand surgery: comparison of 76 carpal tunnel syndrome cases operated using a Hemaclear Model-F tourniquet versus a pneumatic tourniquet","volume":"34","author":"A Pereira","year":"2015","journal-title":"Chir Main"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"e102124","DOI":"10.5812\/aapm.102124","article-title":"Minimal inflation tourniquet pressure using induced hypotension with limb occlusion pressure determination or arterial occlusion pressure estimation in upper limb surgery: a randomized double-blinded comparative study","volume":"10","author":"S A Kasem","year":"2020","journal-title":"Anesth Pain Med"},{"issue":"08","key":"ref6","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1016\/S0883-5403(97)90153-4","article-title":"Thigh pain following tourniquet application in simultaneous bilateral total knee replacement arthroplasty","volume":"12","author":"R L Worland","year":"1997","journal-title":"J Arthroplasty"},{"issue":"08","key":"ref7","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1302\/0301-620X.88B8.17668","article-title":"Tourniquet use and its complications in Norway","volume":"88","author":"A Odinsson","year":"2006","journal-title":"J Bone Joint Surg Br"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1097\/00005373-197904000-00003","article-title":"Pathophysiologic effects distal to a tourniquet in the 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Surg"},{"key":"ref12","first-page":"x","article-title":"Tourniquet-induced ischemia creates increased risk of organ dysfunction and mortality following delayed limb amputation","volume":"x","author":"C J Rowe","year":"2023","journal-title":"Injury"},{"issue":"04","key":"ref13","first-page":"253","article-title":"Complications of and improvements in pneumatic tourniquets used in surgery","volume":"15","author":"J A McEwen","year":"1981","journal-title":"Med Instrum"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1111\/j.1445-2197.1974.tb06402.x","article-title":"Tourniquet paralysis","volume":"44","author":"R W Middleton","year":"1974","journal-title":"Aust N Z J Surg"},{"issue":"05","key":"ref15","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1016\/j.jos.2021.06.011","article-title":"Efficacy of arterial occlusion pressure estimation-based tourniquet pressure settings in upper limb surgery","volume":"27","author":"B 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