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İnfraklaviküler ve interskalen bloğun önkol oksijenasyonuna etkisi: randomize kontrollü bir çalışma

Year 2022, Volume: 47 Issue: 3, 931 - 941, 30.09.2022
https://doi.org/10.17826/cumj.1031005

Abstract

Amaç: Ultrasonografi görüntüleme (USG) eşliğinde yapılan infraklaviküler blok (İKB) ve interskalen blok (İSB), üst ekstremite ameliyatlarında en sık kullanılan brakiyal pleksus blok teknikleridir. Bu blokların uygulanmasından sonra sempatik blokaj oluştuğu ve blokajın neden olduğu vazodilatasyon ile kan akımının arttığı bilinmektedir. Bu çalışmada USG ile birlikte uygulanan İKB ve İSB'nin önkol doku oksijenasyonuna etkisinin karşılaştırılması amaçlandı.
Gereç ve Yöntem: Bu çalışmaya elektif veya acil kol, dirsek veya önkol cerrahisi planlanan 18-65 yaş arası ASA I-III risk gruplarına ait yüz dört hasta dahil edildi. Hastalar iki gruba ayrıldı: Grup İKB ve Grup İSB. Bazal hemodinamik ölçümlere ek olarak, blok öncesi ve blok tamamlandıktan sonra 10., 20. ve 30. dakikalarda Perfüzyon indeksi(PI), ortalama akım hızı(TAV), brakiyal arter çapı(BAÇ), brakiyal arter alanı(BAA), brakiyal arter atım akımı (BF) ve doku oksijen satürasyonu(rSO2) verileri önceden kaydedildi.
Bulgular: Grup İSB ve Grup İKB'deki hastaların demografik verileri karşılaştırıldı, gruplar arasında anlamlı fark saptanmadı. PI ve rSO2 değerlerindeki artış yüzdelerinin zamana göre dağılımı incelendiğinde, gruplar arasında anlamlı farklılıklar bulundu. 0. dakika ile 10., 20. ve 30. dakikalar arasında BF, TAV, BAA ve BAÇ değerlerindeki yüzde artışlarında anlamlı fark yoktu. Grup İSB'de 8 hastada (%15) Horner sendromu, 3 hastada (%5) ani ses kısıklığı gözlendi. Grup İKB'de komplikasyon gelişmedi.
Sonuç: Bu çalışmada İKB ve İSB'nin önkol doku oksijenasyonu üzerindeki etkilerinin karşılaştırıldığı ve İKB'nin rSO2 ve PI değerlerini arttırdığı tespit edilmiştir.

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References

  • 1. Özyalçın SN, Erdine S, Üst ekstremite somatik blokları, In: Özyalçın S, editor. Rejyonel Anestezi, 1st ed. İstanbul; Nobel Tıp Kitabevleri, 2005. p. 83-93.
  • 2. Davis WJ, Lennon RL, Wedel DJ. Brachial plexus anesthesia for outpatient surgical procedures on an upper extremity. Mayo Clin Proc. 1991; 66(5): 470-3. doi: 10.1016/s0025-6196(12)62386-6.
  • 3. Williams SR, Chouinard P, Arcand G, Harris P, Ruel M, Boudreault D, et al. Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesth Analg. 2003; 97(5): 1518-23. doi: 10.1213/01.ane.0000086730.09173.ca.
  • 4. Hadzic A. Textbook of regional anesthesia and acute pain management. McGraw-Hill, Medical Pub., New York, 2007. p. 373-453
  • 5. Iskandar H, Wakim N, Benard A, Manaud B, Ruel-Raymond J, Cochard G, et al. The effects of interscalene brachial plexus block on humeral arterial blood flow: a Doppler ultrasound study. Anesth Analg 2005; 101(1): 279-81 doi: 10.1213/01.ANE.0000154188.15821.E9.
  • 6. Li J, Karmakar MK, Li X, Kwok WH, Ngan Kee WD. Regional hemodynamic changes after an axillary brachial plexus block: a pulsed-wave Doppler ultrasound study. Reg Anesth Pain Med 2012; 37(1): 111-8. doi: 10.1097/AAP.0b013e318234007e
  • 7. Hernández G, Ospina-Tascón GA, Damiani LP, Estenssoro E, Dubin A, Hurtado J et al. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA. 2019; 321(7): 654-664. doi: 10.1001/jama.2019.0071.
  • 8. Dubin A, Henriquez E, Hernández G. Monitoring peripheral perfusion and microcirculation. Curr Opin Crit Care. 2018; 24(3): 173-180. doi: 10.1097/MCC.0000000000000495
  • 9. Kus A, Gurkan Y, Gormus SK, Solak M, Toker K. Usefulness of perfusion index to detect the effect of brachial plexus block. J Clin Monit Comput. 2013; 27(3): 325-8. doi: 10.1007/s10877-013-9439-4
  • 10. Variane GFT, Chock V, Netto A, Pietrobom RFR, Meurs KPV. Simultaneous near-infrared spectroscopy (NIRS) and amplitude-integrated electroencephalography (aEEG): Dual use of brain monitoring techniques improves our understanding of physiology. Front Pediatr 2020; 7: 560. doi: 10.3389/fped.2019.00560. eCollection
  • 11. Van de Velde S, Kalmar AF, Raes M, Poelaert J, Lootens T, Vanoverschelde H. Lower Extremity Near-infrared Spectroscopy After Popliteal Block For Orthopaedic Foot Surgery. Open Orthop J. 2016; 10: 258-63. doi: 10.2174/1874325001610010258
  • 12. Piangatelli C, De Angelis C, Pecora L, Recanatini F, Cerchiara P, Testasecca D. Levobupivacaine and ropivacaine in the infraclavicular brachial plexus block. Minerva Anestesiol. 2006; 72(4): 217-21.
  • 13. Jindal S, Sidhu GK, Sood D, Grewal A. Vibration sensation as an indicator of surgical anesthesia following brachial plexus block. Saudi J Anaesth. 2016; 10(4): 432-435. doi: 10.4103/1658-354X.179114.
  • 14. Galvin EM, Niehof S, Medina HJ, Zijlstra FJ, van Bommel J, Klein J, Verbrugge SJ. Thermographic temperature measurement compared with pinprick and cold sensation in predicting the effectiveness of regional blocks. Anesth Analg. 2006; 102(2): 598-604. doi: 10.1213/01.ane.0000189556.49429.16
  • 15. Nieuwveld D, Mojica V, Herrera AE, Pomés J, Prats A, Sala-Blanch X. Medial approach of ultrasound-guided costoclavicular plexus block and its effects on regional perfussion. Rev Esp Anestesiol Reanim. 2017; 64(4): 198-205. doi: 10.1016/j.redar.2016.09.010.
  • 16. Bharti N, Bhardawaj N, Wig J. Comparison of ultrasound-guided supraclavicular, infraclavicular and below-C6 interscalene brachial plexus block for upper limb surgery: a randomised, observer-blinded study. Anaesth Intensive Care 2015; 43(4): 468-72. doi: 10.1177/0310057X1504300408.
  • 17. Hernandez, A. Salgado, I.; Agreda, G.; Botana, C.; Casas, M.; Nogueron, M. Hypertensive crisis after interscalene block for shoulder surgery, Eur J Anaesthesiol 2006; 23:126.
  • 18. Neal JM. Ultrasound-Guided Regional Anesthesia and Patient Safety: Update of an Evidence-Based Analysis. Reg Anesth Pain Med. 2016; 41(2): 195-204. doi: 10.1097/AAP.0000000000000295.
  • 19. Weinberg GL. Treatment of local anesthetic systemic toxicity (LAST). Reg Anesth Pain Med. 2010; 35(2): 188-93. doi: 10.1097/AAP.0b013e3181d246c3.
  • 20. Høiseth LØ, Hisdal J, Hoff IE, Hagen OA, Landsverk SA, Kirkebøen KA. Tissue oxygen saturation and finger perfusion index in central hypovolemia: influence of pain. Crit Care Med. 2015; 43(4): 747-56. doi: 10.1097/CCM.0000000000000766
  • 21. Hales JR, Stephens FR, Fawcett AA, Daniel K, Sheahan J, Westerman RA, et al. Observations on a new non-invasive monitor of skin blood flow. Clin Exp Pharmacol Physiol. 1989; 16(5): 403-15. doi: 10.1111/j.1440-1681.1989.tb01578.x.
  • 22. Abdelnasser A, Abdelhamid B, Elsonbaty A, Hasanin A, Rady A. Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index. Br J Anaesth. 2017; 119(2): 276-280.doi: 10.1093/bja/aex166
  • 23. Ginosar Y, Weiniger CF, Meroz Y, Kurz V, Bdolah-Abram T, Babchenko A, et al. Pulse oximeter perfusion index as an early indicator of sympathectomy after epidural anesthesia. Acta Anaesthesiol Scand. 2009; 53(8): 1018-26. doi: 10.1111/j.1399-6576.2009.01968.x
  • 24. Kolny M, Stasiowski MJ, Zuber M, Marciniak R, Chabierska E, Pluta A, et al. Randomized, comparative study of the effectiveness of three different techniques of interscalene brachial plexus block using 0.5% ropivacaine for shoulder arthroscopy. Anaesthesiol Intensive Ther. 2017; 49(1): 47-52. doi: 10.5603/AIT.2017.0009
  • 25. Li T, Ye Q, Wu D, Li J, Yu J. Dose-response studies of Ropivacaine in blood flow of upper extremity after supraclavicular block: a double-blind randomized controlled study. BMC Anesthesiol. 2017; 17(1): 161. doi: 10.1186/s12871-017-0447-7
  • 26. Bereket MM, Aydin BG, Küçükosman G, Pişkin Ö, Okyay RD, Ayoğlu FN, et al. Perfusion Index and ultrasonography in the evaluation of infraclavicular block. Minerva Anestesiol. 2019; 85(7): 746-755. doi: 10.23736/S0375-9393.18.13046-X.
  • 27. Tighe PJ, Elliott CE, Lucas SD, Boezaart AP. Noninvasive tissue oxygen saturation determined by near-infrared spectroscopy following peripheral nerve block. Acta Anaesthesiol Scand. 2011; 55(10): 1239-46. doi: 10.1111/j.1399-6576.2011.02533.x
  • 28. Karahan MA, Binici O, Buyukfirat E. Tissue Oxygen Saturation Change on Upper Extremities After Ultrasound-Guided Infraclavicular Brachial Plexus Blockade; Prospective Observational Study. Medicina (Kaunas). 2019 Jun; 55(6): 274. doi: 10.3390/medicina55060274
  • 29. Park SK, Lee SY, Kim WH, Park HS, Lim YJ, Bahk JH. Comparison of Supraclavicular and Infraclavicular Brachial Plexus Block: A Systemic Review of Randomized Controlled Trials. Anesth Analg. 2017; 124(2): 636-644. doi: 10.1213/ANE.0000000000001713

Effect of infraclavicular and interscalene block on oxygenation of the forearm: a randomized controlled study

Year 2022, Volume: 47 Issue: 3, 931 - 941, 30.09.2022
https://doi.org/10.17826/cumj.1031005

Abstract

Purpose: Infraclavicular block (ICB) and interscalene block (ISB) accompanied by ultrasonography imaging (USI) are the most frequently used brachial plexus block techniques in upper extremity surgeries. It is already known that sympathetic blockage occurs after the application of these blocks, and blood flow increases with vasodilatation caused by the blockage. This study aimed to compare the effect of ICB and ISB, which are applied together with USI, on forearm tissue oxygenation.
Materials and Methods: A hundred-four patients were included in this study belonging to ASA I-III risk groups, aged 18–65 years, who were scheduled for elective or emergency arm, elbow, or forearm surgery. The patients were divided into two groups: Group ICB and Group ISB. In addition to the baseline hemodynamic measurements, PI, time average velocity (TAV), brachial artery diameter (BAD), brachial arterial area (BAA), brachial artery beat flow (BF), and tissue oxygen saturation (rSO2) data were recorded before block and at the 10th, 20th, and 30th min after the block was completed.
Results: The demographic data of the patients in the Group ICB and Group ISB were compared, no significant differences were detected between the groups. When the distribution of the percentage increase in PI and rSO2 values according to time was examined, significant differences were found between the groups. There were no significant differences in the percentage increases in BF, TAV, BAA, and BAD values between the 0th minute and at 10th, 20th, and 30th min (p>0.05). Horner syndrome was observed in 8 patients (15%) and sudden hoarseness was observed in 3 patients (5%) in Group ISB. No complications developed in the Group ICB.
Conclusion: This study shows that the effects of ICB and ISB on forearm tissue oxygenation were compared and it was found that ICB increased rSO2 and PI values.

References

  • 1. Özyalçın SN, Erdine S, Üst ekstremite somatik blokları, In: Özyalçın S, editor. Rejyonel Anestezi, 1st ed. İstanbul; Nobel Tıp Kitabevleri, 2005. p. 83-93.
  • 2. Davis WJ, Lennon RL, Wedel DJ. Brachial plexus anesthesia for outpatient surgical procedures on an upper extremity. Mayo Clin Proc. 1991; 66(5): 470-3. doi: 10.1016/s0025-6196(12)62386-6.
  • 3. Williams SR, Chouinard P, Arcand G, Harris P, Ruel M, Boudreault D, et al. Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesth Analg. 2003; 97(5): 1518-23. doi: 10.1213/01.ane.0000086730.09173.ca.
  • 4. Hadzic A. Textbook of regional anesthesia and acute pain management. McGraw-Hill, Medical Pub., New York, 2007. p. 373-453
  • 5. Iskandar H, Wakim N, Benard A, Manaud B, Ruel-Raymond J, Cochard G, et al. The effects of interscalene brachial plexus block on humeral arterial blood flow: a Doppler ultrasound study. Anesth Analg 2005; 101(1): 279-81 doi: 10.1213/01.ANE.0000154188.15821.E9.
  • 6. Li J, Karmakar MK, Li X, Kwok WH, Ngan Kee WD. Regional hemodynamic changes after an axillary brachial plexus block: a pulsed-wave Doppler ultrasound study. Reg Anesth Pain Med 2012; 37(1): 111-8. doi: 10.1097/AAP.0b013e318234007e
  • 7. Hernández G, Ospina-Tascón GA, Damiani LP, Estenssoro E, Dubin A, Hurtado J et al. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA. 2019; 321(7): 654-664. doi: 10.1001/jama.2019.0071.
  • 8. Dubin A, Henriquez E, Hernández G. Monitoring peripheral perfusion and microcirculation. Curr Opin Crit Care. 2018; 24(3): 173-180. doi: 10.1097/MCC.0000000000000495
  • 9. Kus A, Gurkan Y, Gormus SK, Solak M, Toker K. Usefulness of perfusion index to detect the effect of brachial plexus block. J Clin Monit Comput. 2013; 27(3): 325-8. doi: 10.1007/s10877-013-9439-4
  • 10. Variane GFT, Chock V, Netto A, Pietrobom RFR, Meurs KPV. Simultaneous near-infrared spectroscopy (NIRS) and amplitude-integrated electroencephalography (aEEG): Dual use of brain monitoring techniques improves our understanding of physiology. Front Pediatr 2020; 7: 560. doi: 10.3389/fped.2019.00560. eCollection
  • 11. Van de Velde S, Kalmar AF, Raes M, Poelaert J, Lootens T, Vanoverschelde H. Lower Extremity Near-infrared Spectroscopy After Popliteal Block For Orthopaedic Foot Surgery. Open Orthop J. 2016; 10: 258-63. doi: 10.2174/1874325001610010258
  • 12. Piangatelli C, De Angelis C, Pecora L, Recanatini F, Cerchiara P, Testasecca D. Levobupivacaine and ropivacaine in the infraclavicular brachial plexus block. Minerva Anestesiol. 2006; 72(4): 217-21.
  • 13. Jindal S, Sidhu GK, Sood D, Grewal A. Vibration sensation as an indicator of surgical anesthesia following brachial plexus block. Saudi J Anaesth. 2016; 10(4): 432-435. doi: 10.4103/1658-354X.179114.
  • 14. Galvin EM, Niehof S, Medina HJ, Zijlstra FJ, van Bommel J, Klein J, Verbrugge SJ. Thermographic temperature measurement compared with pinprick and cold sensation in predicting the effectiveness of regional blocks. Anesth Analg. 2006; 102(2): 598-604. doi: 10.1213/01.ane.0000189556.49429.16
  • 15. Nieuwveld D, Mojica V, Herrera AE, Pomés J, Prats A, Sala-Blanch X. Medial approach of ultrasound-guided costoclavicular plexus block and its effects on regional perfussion. Rev Esp Anestesiol Reanim. 2017; 64(4): 198-205. doi: 10.1016/j.redar.2016.09.010.
  • 16. Bharti N, Bhardawaj N, Wig J. Comparison of ultrasound-guided supraclavicular, infraclavicular and below-C6 interscalene brachial plexus block for upper limb surgery: a randomised, observer-blinded study. Anaesth Intensive Care 2015; 43(4): 468-72. doi: 10.1177/0310057X1504300408.
  • 17. Hernandez, A. Salgado, I.; Agreda, G.; Botana, C.; Casas, M.; Nogueron, M. Hypertensive crisis after interscalene block for shoulder surgery, Eur J Anaesthesiol 2006; 23:126.
  • 18. Neal JM. Ultrasound-Guided Regional Anesthesia and Patient Safety: Update of an Evidence-Based Analysis. Reg Anesth Pain Med. 2016; 41(2): 195-204. doi: 10.1097/AAP.0000000000000295.
  • 19. Weinberg GL. Treatment of local anesthetic systemic toxicity (LAST). Reg Anesth Pain Med. 2010; 35(2): 188-93. doi: 10.1097/AAP.0b013e3181d246c3.
  • 20. Høiseth LØ, Hisdal J, Hoff IE, Hagen OA, Landsverk SA, Kirkebøen KA. Tissue oxygen saturation and finger perfusion index in central hypovolemia: influence of pain. Crit Care Med. 2015; 43(4): 747-56. doi: 10.1097/CCM.0000000000000766
  • 21. Hales JR, Stephens FR, Fawcett AA, Daniel K, Sheahan J, Westerman RA, et al. Observations on a new non-invasive monitor of skin blood flow. Clin Exp Pharmacol Physiol. 1989; 16(5): 403-15. doi: 10.1111/j.1440-1681.1989.tb01578.x.
  • 22. Abdelnasser A, Abdelhamid B, Elsonbaty A, Hasanin A, Rady A. Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index. Br J Anaesth. 2017; 119(2): 276-280.doi: 10.1093/bja/aex166
  • 23. Ginosar Y, Weiniger CF, Meroz Y, Kurz V, Bdolah-Abram T, Babchenko A, et al. Pulse oximeter perfusion index as an early indicator of sympathectomy after epidural anesthesia. Acta Anaesthesiol Scand. 2009; 53(8): 1018-26. doi: 10.1111/j.1399-6576.2009.01968.x
  • 24. Kolny M, Stasiowski MJ, Zuber M, Marciniak R, Chabierska E, Pluta A, et al. Randomized, comparative study of the effectiveness of three different techniques of interscalene brachial plexus block using 0.5% ropivacaine for shoulder arthroscopy. Anaesthesiol Intensive Ther. 2017; 49(1): 47-52. doi: 10.5603/AIT.2017.0009
  • 25. Li T, Ye Q, Wu D, Li J, Yu J. Dose-response studies of Ropivacaine in blood flow of upper extremity after supraclavicular block: a double-blind randomized controlled study. BMC Anesthesiol. 2017; 17(1): 161. doi: 10.1186/s12871-017-0447-7
  • 26. Bereket MM, Aydin BG, Küçükosman G, Pişkin Ö, Okyay RD, Ayoğlu FN, et al. Perfusion Index and ultrasonography in the evaluation of infraclavicular block. Minerva Anestesiol. 2019; 85(7): 746-755. doi: 10.23736/S0375-9393.18.13046-X.
  • 27. Tighe PJ, Elliott CE, Lucas SD, Boezaart AP. Noninvasive tissue oxygen saturation determined by near-infrared spectroscopy following peripheral nerve block. Acta Anaesthesiol Scand. 2011; 55(10): 1239-46. doi: 10.1111/j.1399-6576.2011.02533.x
  • 28. Karahan MA, Binici O, Buyukfirat E. Tissue Oxygen Saturation Change on Upper Extremities After Ultrasound-Guided Infraclavicular Brachial Plexus Blockade; Prospective Observational Study. Medicina (Kaunas). 2019 Jun; 55(6): 274. doi: 10.3390/medicina55060274
  • 29. Park SK, Lee SY, Kim WH, Park HS, Lim YJ, Bahk JH. Comparison of Supraclavicular and Infraclavicular Brachial Plexus Block: A Systemic Review of Randomized Controlled Trials. Anesth Analg. 2017; 124(2): 636-644. doi: 10.1213/ANE.0000000000001713
There are 29 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research
Authors

Eren Açıkgöz This is me 0000-0002-3084-7339

Özcan Pişkin 0000-0003-3538-0317

Bengü Gülhan Aydın 0000-0002-1324-6144

Rahşan Dilek Okyay 0000-0002-0520-7532

Gamze Küçükosman 0000-0001-5224-0258

Hilal Ayoğlu 0000-0002-6869-5932

Publication Date September 30, 2022
Acceptance Date June 3, 2022
Published in Issue Year 2022 Volume: 47 Issue: 3

Cite

MLA Açıkgöz, Eren et al. “Effect of Infraclavicular and Interscalene Block on Oxygenation of the Forearm: A Randomized Controlled Study”. Cukurova Medical Journal, vol. 47, no. 3, 2022, pp. 931-4, doi:10.17826/cumj.1031005.