[Pneumatic tourniquet paralysis. A differential diagnosis after loco-regional anesthesia of the upper limb]

Abstract

A case is reported of a severe neurological deficit after hand surgical using pneumatic tourniquet. The 51 year old ASA I patient underwent an axillary block for hand surgery using 50 ml of mepivacaine 1%. The tourniquet was remained at 300 mmHg for only 45 min. The following day, the patient's arm remained lumb. Electrophysiologic tests showed a severe conduction block of sensory and motor fibers, well localized to the presume lower margin of the tourniquet. As there was no improvement, epineurotomy was carried out on day 60, to liberate the median nerve which was severely compressed in the canal brachial. The patient then started to improve slowly. But many safety factors can decrease the rate complications: the accuracy and integrity of the pressure-monitoring must be verified, a tourniquet pressure above 300-500 mmHg would rarely be required in normotensive patient with compliant vessel, a pressure of 200 mmHg will almost all cases provide a bloodless field, tourniquet must be applied on diaphysis and not on bony relief.