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Evaluation of the success of supraclavicular blockade performed under general anesthesia in arthroscopic surgery of the shoulder by using Perfusion Index

Yıl 2020, Cilt: 12 Sayı: 1, 61 - 68, 01.03.2020
https://doi.org/10.21601/ortadogutipdergisi.626306

Öz

Aim: Supraclavicular blockade under ultrasonic-guidance has recently increased its popularity and is an alternative to anesthesia and analgesia in arthroscopic surgery of the shoulder.

The aim of this study is to evaluate the effectiveness of the perfusion index (PI) which indicates the increase in peripheral perfusion of the upper extremity in determining the success of single dose supraclavicular nerve block under general anesthesia.

Material and Methods: The PI was measured non-invasively with pulse-oximetry probe (Masimo Corp, Irvine, CA, USA) from the fingers at the same and opposite sides of blockade at the beginning, 5th, 10th, 20th, 30th minutes, postoperatively and in post anesthesia care unit (PACU). The pain scores were recorded in the PACU, post-operatively and at the 1st, 12th, and 24th hours. Preoperative and postoperative arterial pressures and pulse rates were monitored and recorded at the beginning, 5th, 10th, 20th, 30th minutes, postoperatively and in PACU.

Results: Mean PI change rate measured at the beginning was significantly higher than those measured in all other times and when compared to the initial PI change rate, the rates of change were found to increase significantly in the 5th, 10th and 20th minutes (p<0.001). Mean arterial pressure and mean heart rate values measured at the beginning were significantly higher than those measured at all times (p<0.001). No intraoperative injection of fentanyl or infusion of remifentanyl were performed. The patients had no additional requirement of narcotics during the 24-hours follow-up period postoperatively, except for routine analgesics.

Conclusions: We think that peripheral blocks; especially in multimodal anesthetic applications, have intraoperative analgesic activity in addition to postoperative efficacy. They may also contribute to hemodynamic stabilization without narcotic requirement. The success of the blockade can reliably be evaluated by the PI measurement.

Kaynakça

  • Kavaja L, Malmivaara A, Lahdeoja T, et al. Shoulder Capsular Surgery in Finland Between 1999 And 2008: A Nationwide Register Analysis. Scandinavian journal of surgery. 2018. (doi: 10.1177/1457496917748219).
  • Huang R, Wang S, Wang Y et al. Systematic Review of All -Arthroscopic Versus Mini -Open Repair of Rotator Cuff Tears: A Meta -Analysis. Scientific Reports. 2016;6:228-57.
  • Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia. 2010;65:608-24
  • Hussain N, Goldar G, Ragina N, et al. Suprascapular and Interscalene Nerve Block for Shoulder Surgery: A Systematic Review and Meta-analysis. Anesthesiology. 2017;127:998-1013.
  • Su HH, Lui PW, Yu CL, et al. The effects of continuous axillary brachial plexus block with ropivacaine infusion on skin temperature and survival of crushed fingers after microsurgical replantation. Chang Gung medical journal. 2005;28:567-74.
  • Loland VJ, Ilfeld BM, Abrams RA, et al. Ultrasound-guided perineural catheter and local anesthetic infusion in the perioperative management of pediatric limb salvage: a case report. Paediatric Anesthesia. 2009;19:905-7.
  • Perlas A, Lobo G, Lo N, et al. Ultrasound guided supraclavicular block: results of 510 consecutive cases. Regional Anesthesia and Pain Medicine. 2009;34:171–6
  • Neal JM, Gerancher JC, Hebl JR, et al. Upper extremity regional anesthesia: essentials of our current understanding, 2008. Regional Anesthesia and Pain Medicine 2009;34:134-70.
  • Ghodki PS, Singh ND. Incidence of hemidiaphragmatic paresis after peripheral nerve stimulator versus ultrasound guided interscalene brachial plexus block. Journal of Anaesthesiology Clinical Pharmacology 2016;32:177 -81.
  • Koh WU, Kim HJ, Park HS, et al. A randomised controlled trial comparing continuous supraclavicular and interscalene brachial plexus blockade for open rotator cuff surgery. Anaesthesia. 2016;71:692 –9.
  • Liu SS, Gordon MA, Shaw PM, et al. A prospective clinical registry of ultrasound -guided regional anesthesia for ambulatory shoulder surgery. Anesthesia Analgesia 2010;111:617-23.
  • Brull R, McCartney CJ, Chan VW, et al. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesthesia Analgesia. 2007;104:96574.
  • Hasanin A, Mukhtar A, Nassar H. Perfusion indices revisited. J Intensive Care. 2017;5:24.
  • Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Critical Care Medicine. 2002;30:1210–3.
  • Paul D. Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index: is it really an objective outcome? British Journal of Anaesthesia. 2018;120:405-6.
  • Hermanns H, Werdehausen R, Hollmann MW, et al. Assessment of skin temperature during regional anaesthesia-What the anaesthesiologist should know. Acta Anaesthesiologica Scandinavica. 2018. (doi: 10.1111/aas.13176).
  • Ode K, Selvaraj S, Smith AF Monitoring regional blockade. Anaesthesia. 2017;1:70-5.
  • Kus A, Gurkan Y, Gormus SK, et al. Usefulness of perfusion index to detect the effect of brachial plexus block. The Journal of Clinical Monitoring and Computing 2013;27:325–8.
  • Nakatani T, Hashimoto T, Sutou I, et al. Retention of finger blood flow against postural change as an indicator of successful sympathetic block in the upper limb. 2017;10:475-9.
  • Goldman JM, Petterson MT, Kopotic RJ, et al. Masimo signal extraction pulse oximetry. The Journal of Clinical Monitoring and Computing. 2000;16:475–83.
  • Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. The Journal of Clinical Anesthesia 1996;8:63–79.
  • Bedford RF. Circulatory responses to tracheal intubation. In: Eichhorn JH, Kirby RB, Brown DL, editors. Problems in Anesthesia, Philedelphia: Lippincott; 1998;203–10.
  • Derbyshire DR, Chmielewski A, Fell D, et al. Plasma catecholamine responses to tracheal intubation. British Journal of Anaesthesia 1983;55:855–60.
  • Ozzeybek D, Oztekin S, Mavioglu O. Comparison of the haemodynamic effects of interscalene block combined with general anaesthesia and interscalene block alone for shoulder surgery. Journal of International Medical Research. 2003;3:428–33.
  • Kim JH, Song SY, Ryu T, et al. Changes in heart rate variability after sitting following interscalene block. Clinical Autonomic Research. 2015;25:327–33.
  • Simeoforidou M, Vretzakis G, Chantzi E, et al. Effect of interscalene brachial plexus block on heart rate variability. Korean Journal Anesthesiol 2013;64:432–8.
  • Kahverengi DL, Bridenbaugh LD. Kuzenler MJ, et al. editors. Upper extremity somatic block. Neural Blockade in Clinical Anesthesia and Pain Medicine. Philadelphia: Lippincott. 2009;316–342.
  • Kakazu C, Tokhner V, Li J, et al. In the new era of ultrasound guidance: is pneumothorax from supraclavicular block a rare complication of the past? British Journal of Anaesthesia. 2014;113:190–1.
  • Trabelsi W, Ben Gabsia A, Lebbi A, et al. Suprascapular block associated with supraclavicular block: An alternative to isolated interscalene block for analgesia in shoulder instability surgery? Orthopaedics Traumatology Surgery Research 2017;103:77-83.
  • Ryu T, Kil BT, Kim JH. Comparison Between Ultrasound -Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Patients Undergoing Arthroscopic Shoulder Surgery: A Prospective, Randomized, Parallel Study. Medicine. 2015;94:1726.
  • Karaman T, Karaman S, Tapar H, et al. Comparison of Ultrasound -Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Postoperative Pain Management After Arthroscopic Shoulder Surgery, Pain Practice. 2018. (doi: 10.1111/papr.12733).
  • Siegenthaler A, Moriggl B, Mlekusch S, et al. Ultrasound -guided suprascapular nerve block, description of a novel supraclavicular approach. Regional Anesthesia and Pain Medicine. 2012;37:325–8.
  • Cornish P. Supraclavicular block: new perspectives. Regional Anesthesia and Pain Medicine 2009;34:607–8.
  • Galvin EM, Niehof S, Medina HJ, et al. Thermographic temperature measurement compared with pinprick and cold sensation in predicting the effectiveness of regional blocks. Anesthesia & Analgesia. 2006;102:598–604.
  • Bergek C, Zdolsek JH, Hahn RG. Accuracy of noninvasive haemoglobin measurement by pulse oximetry depends on the type of infusion fluid. European Journal of Anaesthesiology. 2012;29:586–92.
  • Abdelnasser B, Abdelhamid A, Elsonbaty A, et al. Rady Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index A. British Journal of Anaesthesia, 2017;119:276–80.
  • Yamazaki H, Nishiyama J, Suzuki T. Use of perfusion index from pulse oximetry to determine efficacy of stellate ganglion block. Local and Regional Anesthesia. 2012;5:9–14.
  • Sebastiani A, Philippi L, Boehme S, et al. Perfusion index and plethysmographic variability index in patients with interscalene nerve catheters. Canadian Journal of Anesthesia. 2012;59:1095–101.

Artroskopik omuz cerrahisinde genel anestezi altında yapılan supraklaviküler blokajın başarısının Perfüzyon İndeksi kullanılarak değerlendirilmesi

Yıl 2020, Cilt: 12 Sayı: 1, 61 - 68, 01.03.2020
https://doi.org/10.21601/ortadogutipdergisi.626306

Öz

Amaç: Ultrason kılavuzluğu altındaki supraklaviküler blokaj son zamanlarda popülerliğini arttırmıştır ve omuz artroskopik cerrahisinde anestezi ve analjeziye alternatif olmaktadır.

Bu çalışmanın amacı, genel anestezi altında tek doz supraklaviküler sinir bloğunun başarısını belirlemede üst ekstremitenin periferal perfüzyonundaki artışı belirten Perfüzyon İndeks (PI) değerinin etkinliğini değerlendirmektir.

Gereç ve Yöntemler: PI değeri blokaj öncesi başlangıçta, blokajdan sonraki 5., 10., 20., 30. dakikalarda ve anestezi sonrası bakım ünitesinde (PACU) blokajın aynı ekstremite tarafından ve diğer tarafındaki parmaklarından nabız-oksimetri probu (Masimo Corp, Irvine, CA, ABD) ile non invazif şekilde ölçülmüştür. Ağrı skorları ameliyat sonrası ve 1., 12. ve 24. saatlerde PACU’da kaydedildi. Ameliyat öncesi ve ameliyat sonrası arter basınçları ve nabızları, ameliyat öncesi, ameliyat sonrası ve PACU’da 5., 10., 20., 30. dakikalarda izlendi ve kaydedildi.

Bulgular: Başlangıçta ölçülen ortalama PI değişim oranı, diğer tüm zamanlarda ölçülenlerden anlamlı derecede yüksekti ve ilk PI değişim oranı ile karşılaştırıldığında, değişim oranlarının 5., 10. ve 20. dakikalarda anlamlı şekilde arttığı bulundu (p<0,001). Başlangıçta ölçülen ortalama ​​arter basıncı, ortalama kalp atış hızı değeri diğer zamanlarda ölçülenlerden anlamlı derecede yüksekti (p<0,001). Hiçbir intraoperatif fentanil enjeksiyonu veya remifentanil infüzyonu gerçekleştirilmedi. Hastaların postoperatif 24 saatlik takiplerinde rutin analjezikler dışında ek narkotik gereksinimi yoktu.

Sonuç: Periferik bloklar özellikle multimodal anestezik uygulamalarda postoperatif etkinliğin yanı sıra intraoperatif analjezik aktiviteye sahiptir, narkotik gereksinimi olmadan hemodinamik stabilizasyona katkıda bulunabilirler ve PI ölçümü blokajın başarısının değerlendirilmesinde güvenilir bir yöntem olabilir.

Kaynakça

  • Kavaja L, Malmivaara A, Lahdeoja T, et al. Shoulder Capsular Surgery in Finland Between 1999 And 2008: A Nationwide Register Analysis. Scandinavian journal of surgery. 2018. (doi: 10.1177/1457496917748219).
  • Huang R, Wang S, Wang Y et al. Systematic Review of All -Arthroscopic Versus Mini -Open Repair of Rotator Cuff Tears: A Meta -Analysis. Scientific Reports. 2016;6:228-57.
  • Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia. 2010;65:608-24
  • Hussain N, Goldar G, Ragina N, et al. Suprascapular and Interscalene Nerve Block for Shoulder Surgery: A Systematic Review and Meta-analysis. Anesthesiology. 2017;127:998-1013.
  • Su HH, Lui PW, Yu CL, et al. The effects of continuous axillary brachial plexus block with ropivacaine infusion on skin temperature and survival of crushed fingers after microsurgical replantation. Chang Gung medical journal. 2005;28:567-74.
  • Loland VJ, Ilfeld BM, Abrams RA, et al. Ultrasound-guided perineural catheter and local anesthetic infusion in the perioperative management of pediatric limb salvage: a case report. Paediatric Anesthesia. 2009;19:905-7.
  • Perlas A, Lobo G, Lo N, et al. Ultrasound guided supraclavicular block: results of 510 consecutive cases. Regional Anesthesia and Pain Medicine. 2009;34:171–6
  • Neal JM, Gerancher JC, Hebl JR, et al. Upper extremity regional anesthesia: essentials of our current understanding, 2008. Regional Anesthesia and Pain Medicine 2009;34:134-70.
  • Ghodki PS, Singh ND. Incidence of hemidiaphragmatic paresis after peripheral nerve stimulator versus ultrasound guided interscalene brachial plexus block. Journal of Anaesthesiology Clinical Pharmacology 2016;32:177 -81.
  • Koh WU, Kim HJ, Park HS, et al. A randomised controlled trial comparing continuous supraclavicular and interscalene brachial plexus blockade for open rotator cuff surgery. Anaesthesia. 2016;71:692 –9.
  • Liu SS, Gordon MA, Shaw PM, et al. A prospective clinical registry of ultrasound -guided regional anesthesia for ambulatory shoulder surgery. Anesthesia Analgesia 2010;111:617-23.
  • Brull R, McCartney CJ, Chan VW, et al. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesthesia Analgesia. 2007;104:96574.
  • Hasanin A, Mukhtar A, Nassar H. Perfusion indices revisited. J Intensive Care. 2017;5:24.
  • Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Critical Care Medicine. 2002;30:1210–3.
  • Paul D. Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index: is it really an objective outcome? British Journal of Anaesthesia. 2018;120:405-6.
  • Hermanns H, Werdehausen R, Hollmann MW, et al. Assessment of skin temperature during regional anaesthesia-What the anaesthesiologist should know. Acta Anaesthesiologica Scandinavica. 2018. (doi: 10.1111/aas.13176).
  • Ode K, Selvaraj S, Smith AF Monitoring regional blockade. Anaesthesia. 2017;1:70-5.
  • Kus A, Gurkan Y, Gormus SK, et al. Usefulness of perfusion index to detect the effect of brachial plexus block. The Journal of Clinical Monitoring and Computing 2013;27:325–8.
  • Nakatani T, Hashimoto T, Sutou I, et al. Retention of finger blood flow against postural change as an indicator of successful sympathetic block in the upper limb. 2017;10:475-9.
  • Goldman JM, Petterson MT, Kopotic RJ, et al. Masimo signal extraction pulse oximetry. The Journal of Clinical Monitoring and Computing. 2000;16:475–83.
  • Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. The Journal of Clinical Anesthesia 1996;8:63–79.
  • Bedford RF. Circulatory responses to tracheal intubation. In: Eichhorn JH, Kirby RB, Brown DL, editors. Problems in Anesthesia, Philedelphia: Lippincott; 1998;203–10.
  • Derbyshire DR, Chmielewski A, Fell D, et al. Plasma catecholamine responses to tracheal intubation. British Journal of Anaesthesia 1983;55:855–60.
  • Ozzeybek D, Oztekin S, Mavioglu O. Comparison of the haemodynamic effects of interscalene block combined with general anaesthesia and interscalene block alone for shoulder surgery. Journal of International Medical Research. 2003;3:428–33.
  • Kim JH, Song SY, Ryu T, et al. Changes in heart rate variability after sitting following interscalene block. Clinical Autonomic Research. 2015;25:327–33.
  • Simeoforidou M, Vretzakis G, Chantzi E, et al. Effect of interscalene brachial plexus block on heart rate variability. Korean Journal Anesthesiol 2013;64:432–8.
  • Kahverengi DL, Bridenbaugh LD. Kuzenler MJ, et al. editors. Upper extremity somatic block. Neural Blockade in Clinical Anesthesia and Pain Medicine. Philadelphia: Lippincott. 2009;316–342.
  • Kakazu C, Tokhner V, Li J, et al. In the new era of ultrasound guidance: is pneumothorax from supraclavicular block a rare complication of the past? British Journal of Anaesthesia. 2014;113:190–1.
  • Trabelsi W, Ben Gabsia A, Lebbi A, et al. Suprascapular block associated with supraclavicular block: An alternative to isolated interscalene block for analgesia in shoulder instability surgery? Orthopaedics Traumatology Surgery Research 2017;103:77-83.
  • Ryu T, Kil BT, Kim JH. Comparison Between Ultrasound -Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Patients Undergoing Arthroscopic Shoulder Surgery: A Prospective, Randomized, Parallel Study. Medicine. 2015;94:1726.
  • Karaman T, Karaman S, Tapar H, et al. Comparison of Ultrasound -Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Postoperative Pain Management After Arthroscopic Shoulder Surgery, Pain Practice. 2018. (doi: 10.1111/papr.12733).
  • Siegenthaler A, Moriggl B, Mlekusch S, et al. Ultrasound -guided suprascapular nerve block, description of a novel supraclavicular approach. Regional Anesthesia and Pain Medicine. 2012;37:325–8.
  • Cornish P. Supraclavicular block: new perspectives. Regional Anesthesia and Pain Medicine 2009;34:607–8.
  • Galvin EM, Niehof S, Medina HJ, et al. Thermographic temperature measurement compared with pinprick and cold sensation in predicting the effectiveness of regional blocks. Anesthesia & Analgesia. 2006;102:598–604.
  • Bergek C, Zdolsek JH, Hahn RG. Accuracy of noninvasive haemoglobin measurement by pulse oximetry depends on the type of infusion fluid. European Journal of Anaesthesiology. 2012;29:586–92.
  • Abdelnasser B, Abdelhamid A, Elsonbaty A, et al. Rady Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index A. British Journal of Anaesthesia, 2017;119:276–80.
  • Yamazaki H, Nishiyama J, Suzuki T. Use of perfusion index from pulse oximetry to determine efficacy of stellate ganglion block. Local and Regional Anesthesia. 2012;5:9–14.
  • Sebastiani A, Philippi L, Boehme S, et al. Perfusion index and plethysmographic variability index in patients with interscalene nerve catheters. Canadian Journal of Anesthesia. 2012;59:1095–101.
Toplam 38 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma makaleleri
Yazarlar

Ayşegül Ceylan 0000-0003-2816-2629

Mehmet Burak Eşkin 0000-0001-6781-9334

Yayımlanma Tarihi 1 Mart 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 12 Sayı: 1

Kaynak Göster

Vancouver Ceylan A, Eşkin MB. Evaluation of the success of supraclavicular blockade performed under general anesthesia in arthroscopic surgery of the shoulder by using Perfusion Index. otd. 2020;12(1):61-8.

e-ISSN: 2548-0251

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