ABSTRACT
The limb is then desanguinated by wrapping it with an Esmarch bandage; the elastic bandaging material begins at the distal aspect of the limb and is wrapped tightly in a proximal direction. A tourniquet is then placed immediately proximal to the Esmarch bandage. The tourniquet must be tight enough to overcome arterial blood pressure. After securing the tourniquet, the Esmarch bandage is removed and the drug is injected intravenously with light pressure. Continued occlusion of vessels in an area of the limb that has already been desensitized often reduces the level of tourniquet pain experienced by the patient. Total volume injected will depend upon the size of the area that is occluded by the tourniquet. The tourniquet should be removed slowly to avoid rapid introduction of a large volume of lidocaine into the systemic circulation. Ischemic limb damage can occur if tourniquet is in place for more than 90 minutes.
