Introduction
toxicity, fracture, pain, tourniquet pain, Tourniquet pain
ADVERSE EFFECTS, MINOR, COMPLICATION
For limb surgeries, tourniquets are used to create a bloodless surgical field. Although the standard tourniquet pressure is commonly used, it may apply an amount of pressure that is higher than necessary and may cause some adverse effects [Tourniquet pain is a common complaint for patients in minor hand surgery, many anesthesia techniques, tourniquet position and even if necessity of tourniquet used have been proposed for alleviate this problem.The Wide-awake Local Anesthesia No Tourniquet (WALANT) technique has become increasingly popular in hand surgery. The benefit of this technique is the ability to assess the active movement during the operation such as flexor tendon repair or fracture fixation [Another useful tourniquet technique is intravenous regional anesthesia or Bier block regional technique which could be performed for most upper extremity surgery, there switching of the tourniquet from the distal cuff to the proximal cuff that eliminates tourniquet pain after 20 min. The advantage of this technique is the procedure time can proceed for up to 90 min, thus there is more suitable for major operation. However, there is a challenging technique and require waiting time for pain subside compared with the minor surgery and some complication was reported of anesthetic toxicity after tourniquet released [Limb occlusion pressure (LOP) is the minimum pressure that can stop blood flow between the proximal and distal parts of the limb, which varies for each person. The LOP plus a safety margin, adding to prevent blood pressure fluctuation, can be used as the optimal tourniquet pressure or recommended tourniquet pressure (RTP) [Currently, a Doppler stethoscope is the gold standard to obtain the LOP [From previous studies, RTP can sufficiently maintain the quality of bloodless field during operations with lower pressure than standard tourniquet pressure [