**5. Pressure**

Clinical and experimental studies supported a positive correlation between the degree of neuromuscular injury and the amount of pressure or the ischemia duration. Olivecrona et al. [16] reported a higher cuff pressure increase risks of tourniquet-related postoperative complications. Despite various pressures being used in different studies, the general consensus is that the tourniquet should be employed at the lowest pressure and for the least ischemic time possible to avoid complications. In some published studies [17, 34, 53, 63], cuff pressures, ranging from 300 to 350 mm Hg, have been reported.

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To reduce the cuff pressure, some surgeons preferred the setting of cuff pressure on the basis of the systolic blood pressure plus a margin of 100 mmHg [34], and less early postoperative pain has been reported [64]. Meanwhile, another common method, twice of the systolic pressure, has also been adopted [65]. Besides, based on the fluctuating systolic pressure, improved devices with timely automated measurement of limb occlusion pressure have been investigated to reduce the cuff pressure [16].
