The effect of elbow position at the time of tourniquet inflation on clinical outcomes.

Objective: The aim of this study was to prospectively investigate the effects of elbow position on perioperative and postoperative clinical outcomes during tourniquet inflation.
Patients and Methods: The patients were divided into two groups based on their elbow position during tourniquet inflation: patients with elbows extended group E (30 patients), patients with flexed elbows group F (30 patients). Both groups were compared in terms of perioperative bloodless surgical field, tourniquet pain, time to onset of pain, and pain in the tourniquet area on the first postoperative day, plus elbow-forearm range of motion deficit on both the perioperative and postoperative first day.
Results: The bloodless surgical field provided by the tourniquet was 0.46 (0-5) in Group E and 0.4 (0-4) in Group F. Perioperative tourniquet pain started in an average of 51 (33-71) minutes in 4 patients in Group E and 49 (31-74) minutes in 5 patients in Group F. Pain was present in 2 patients in both groups in the postoperative tourniquet area. When the preoperatively measured elbow flexion-extension and forearm supination-pronation deficits were compared with the perioperative values, the deficits were 1%, 2%, 1%, 1% in Group E, and 1%, 1%, 2%, 1% in Group F, respectively. When compared with the postoperative values, 1%, 3%, 1%, 1% in Group E and 1%, 2%, 1%, and 1% in Group F were observed, respectively.
Conclusions: There was no statistically significant difference between the two groups, but since repositioning the elbow after the tourniquet is inflated will cause an additional shearing effect on the tissues under the cuff, we recommend inflating the tourniquet in that position in which the operation will be performed in upper extremity surgeries.