title: Wrist tourniquet: the most patient-friendly way of bloodless hand surgery.
abstract: BACKGROUND
  The literature is scarce on wrist tourniquets. In this study, three well-established locations of tourniquet setting including upper arm, proximal forearm, and wrist were compared on the same limb using both clinical as well as biochemical variables in paramedical volunteers.
  
  
  METHODS
  Twenty unmedicated, healthy, paramedical, right-hand dominant volunteers participated in the study. The left upper arms were used for monitoring. Blood pressures and heart rates were monitored and recorded before (baseline) and immediately after the application of the tourniquet, every 5 minutes, and at the time the patient requested deflation. An intravenous cannula (22 G) was placed on the right hand to obtain samples, which were taken at baseline and immediately after deflation of the tourniquet to evaluate the levels of pO2, pCO2, O2 saturation, pH, bicarbonate, blood sugar, lactate, hematocrit, and electrolytes. The tourniquets were applied to the right upper arm, forearm, and wrist of each subject with 5-day intervals between each trial. Subjective discomfort and tourniquet pain levels were recorded. For each trial, tourniquet tolerance and details of discomfort were recorded. Statistical analysis was performed as appropriate.
  
  
  RESULTS
  Twenty volunteers aged 20 to 44 years were included. For each trial, in the first 10 minutes after inflation of the tourniquet, the heart rate and systolic blood pressure were increased compared with baseline values. Diastolic blood pressure was elevated immediately after inflation and remained so until deflation in each trial. Diastolic blood pressure values were higher in the upper-arm tourniquet group compared with wrist. Then pH, pO2, and O2 saturation values were decreased and pCO2 and lactate levels were increased compared with baseline values in each trial. Blood sugar was decreased significantly in the arm group. The decrease in pH, pO2, O2 saturation, and blood sugar in the upper arm group was significantly higher compared with wrist and forearm groups. The lactate value was higher in the upper arm group compared with wrist. Visual analog scale and numerical rating scores were lower in the wrist group compared with others at all times. The longest tourniquet tolerance was in the wrist group. In the wrist group, curling was observed in all subjects but the fingers could easily be extended.
  
  
  CONCLUSIONS
  The wrist tourniquet is the most comfortable technique of bloodless surgery for procedures limited to the hand region.
authors.affiliation: Department of Orthopedics and Traumatology, Selçuk University Meram School of Medicine, Turkey.
authors.forename: Nazim
authors.initials: N
authors.lastname: Karalezli
authors.forename: Cemíle Oztin
authors.initials: CO
authors.lastname: Ogun
authors.forename: Tunç Cevat
authors.initials: TC
authors.lastname: Ogun
authors.forename: Serhat
authors.initials: S
authors.lastname: Yildirim
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Tuncay
mesh_terms: D000328:Adult; D001132:Arm; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D006225:Hand / Q000601:surgery*; D006339:Heart Rate; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D010100:Oxygen / Q000097:blood; D014111:Tourniquets / Q000009:adverse effects; D014953:Wrist
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen