The Use of Upper Extremity Tourniquets in Hand Surgery-Does Tourniquet Location Make a Difference? A Scoping Review.

Introduction: Arm and forearm tourniquets are routinely used in hand surgery to provide a "bloodless" operating field. Though not yet widely adopted, wrist tourniquets have been reported to be a more comfortable option compared to other tourniquet locations. Thus, the primary purpose of this study was to review the use of upper extremity tourniquets in awake hand surgery and report any tourniquet-related outcomes. Methods: Following PRISMA-ScR guidelines, Medline and Embase were searched for primary studies published from inception to August 22, 2024, reporting on the use of upper extremity tourniquets in adult patients undergoing hand surgery with local anesthetic. Tourniquet time and tourniquet tolerance, represented by visual analog scale (VAS) scores, were the main extracted outcomes. Results: Two hundred of 1528 studies were reviewed at the full-text level by 2 reviewers, and 26 studies were included. Four studies incldued both forearm and upper arm tourniquets and were treated as individual studies. Of these, there were 19 studies that used an upper arm tourniquet (n = 931 procedures), 9 studies that used a forearm tourniquet (n = 657 procedures), and 2 studies that used a wrist tourniquet (n = 130 procedures). Average tourniquet time for upper arm, forearm, and wrist tourniquets was 11.4, 11.6, and 16.5 min, respectively, and mean VAS score for tourniquet pain were 4.0, 3.3, and 0.4, respectively. Conclusions: We reviewed the use of upper extremity tourniquets for hand surgery and associated outcomes. While limited, the literature suggests that wrist tourniquets are the most comfortable tourniquet location and are well tolerated by both patients and surgeons. Future comparative clinical studies are required to better assess such outcomes.