Tourniquet pain is a significant challenge in regional anaesthesia, often occurring despite a functioning nerve block. It arises due to progressive tissue compression, ischemia, and unblocked C-fibre stimulation, leading to hypertension, tachypnoea, and patient discomfort. Local and systemic effects include nerve compression, muscle ischemia, metabolic acidosis, and increased intracranial pressure. Prevention strategies involve minimizing tourniquet time (≤120 min), using optimal inflation pressures, and supplementing with multimodal analgesia. Intercostobrachial nerve blocks for upper limbs and intravenous lidocaine for lower limbs can reduce pain. Systemic analgesics, ketamine, and early tourniquet release remain key management strategies.