Comparison of the effects of interscalene, supraclavicular and infraclavicular peripheral nerve blockades on perfusion index

Yıl 2020, Cilt: 12 Sayı: 1, 96 - 102, 01.03.2020

Mehmet Burak Eskin Ayşegül Ceylan

https://doi.org/10.21601/ortadogutipdergisi.646741

Öz

Background: The perfusion index (PI) is a non-invasive method that measures the monitoring and success of peripheral nerve blocks in regional anesthesia. The perfusion index (PI) is an objective non-invasive method of measuring and monitoring the success of peripheral nerve blocks. We compare the effects of interscalene, supraclavicular and infraclavicular blocks on the perfusion index, with the aim being to contribute to the decision-making process regarding the type of block to be selected for surgeries in which increased perfusion is important.
Methods: Included in the study were 60 patients aged between 18 and 60 years with an ASA (American Society of Anesthesiologists) I-II risk rating who were scheduled for upper extremity surgery. An equal number of patients were applied supraclavicular, interscalene and infraclavicular blockades, and the PI was measured non-invasively using a pulse-oximetry probe on the fingers on the same and opposite side of blockade at the beginning, at the 10^th, 20^th and 30^th minutes, postoperatively and in the post-anesthetic care unit (PACU).
Results: After a successful blockade of brachial plexus in all patients, a statistically significant increase in PI values was detected. Aside from the initial values, the mean rate of change in PI was significantly higher in the interscalene group than the supraclavicular and infraclavicular groups (p < 0.001).
Conclusion: PI can be used as a non-invasive monitoring method for the determination of the success of a brachial plexus blockade. Based on the results of the present study, an interscalene blockade may be preferred especially for surgeries in which an increase in tissue perfusion is desired due to its perfusion-enhancing properties when compared to supraclavicular and infraclavicular blocks.

Anahtar Kelimeler

perfusion index, interscalene block, supraclavicular block, infraclavicular block

Interskalen, supraklaviküler ve infraklaviküler periferik sinir blokajlarının perfüzyon indeksi üzerine etkilerinin karşılaştırılması

Öz

Amaç: Perfüzyon indeksi (PI), bölgesel anestezide uygulanan periferik sinir bloklarının monitörizasyonunu ve başarısını ölçen non-invaziv bir yöntemdir. Çalışmamızda interskalen, supraklavikular ve infraklavikular sinir bloklarının perfüzyon indeksi üzerindeki etkilerini karşılaştırdık. Amaç, artan perfüzyonun önemli olduğu ameliyatlar için seçilecek periferik bölgesel anestezi şekline karar alma sürecine katkıda bulunmaktır.
Metod: Çalışmaya 18-60 yaş arası 60 hasta ve üst ekstremite cerrahisi için ASA (Amerikan Anestezistler Derneği) skoru I veya II olan hastalar dahil edildi. Eşit sayıda hastaya supraklavikular, interskalen ve infraklavikular blokaj uygulandı. Başlangıçta, 10., 20. ve 30. Dakika ve anestezi sonrası bakım ünitesinde (PACU) PI değerleri non-invasif olarak ölçüldü.
Bulgular: Tüm hastalarda başarılı bir brakiyal pleksus blokajından sonra PI değerlerinde istatistiksel olarak anlamlı bir artış tespit edildi. İlk tespit edilen değerlere göre, PI’deki ortalama değişim oranı, interskalen grubunda, supraklavikular ve infraklavikular gruplara göre anlamlı derecede yüksekti (p < 0,001).
Sonuç: PI, brakiyal pleksus blokajının başarısının belirlenmesinde invazif olmayan standart bir izleme yöntemi olarak kullanılabilirliği gösterilmiştir. Bu çalışmanın sonuçlarına dayanarak, bir supraklavikular ve infraklavikular bloklara kıyasla perfüzyon arttırıcı özelliklerinden dolayı doku perfüzyonunda bir artışın istendiği ameliyatlar için inteskalen blokaj tercih edilebilir.

Anahtar Kelimeler

perfüzyon indeksi, interskalen blok, supraklavikular blok, infraklavikular blok

Kaynakça

• Hussain N, Goldar G, Ragina N, Banfield L, Laffey JG, Abdallah FW. Suprascapular and Interscalene Nerve Block for Shoulder Surgery: A Systematic Review and Meta-analysis. Anesthesiology. 2017; 127: 998-1013. (doi: 10.1097/ALN. 0000000000001894).
• 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 Med J. 2005; 28: 567-74.
• Loland VJ, Ilfeld BM, Abrams RA, Mariano ER. Ultrasound-guided perineural catheter and local anesthetic infusion in the perioperative management of pediatric limb salvage: a case report. Paediatr Anaesth. 2009; 19: 905-7. (doi: 10.1111/j.1460-9592.2009.03103.x).
• Hermanns H, Werdehausen R, Hollmann MW, Stevens MF. Assessment of skin temperature during regional anaesthesia-What the anaesthesiologist should know. Acta Anaesthesiol Scand. 2018. (doi:10.1111/aas.13176).
• Ode K, Selvaraj S, Smith AF Monitoring regional blockade. Anaesthesia. 2017; 1: 70-5. (doi: 10.1111/anae.13742).
• Nakatani T, Hashimoto T, Sutou I, Saito Y. Retention of finger blood flow against postural change as an indicator of successful sympathetic block in the upper limb. 2017; 10: 475-9. (doi: 10.2147/JPR.S124627).
• Goldman JM, Petterson MT, Kopotic RJ, Barker SJ. Masimo signal extraction pulse oximetry. J Clin Monit Comput; 2000; 16: 475–83.
• 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. Crit Care Med; 2002; 30: 1210–3.
• Paul D. Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index: is it really an objective outcome? Br J Anaesth. 2018; 120: 405-6. (doi: 10.1016/j.bja.2017.12.003).
• 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: 325-8.
• Sebastiani A, Philippi L, Boehme S et al. Perfusion index and plethysmographic variability index in patients with interscalene nerve catheters. Can J Anaesth2012; 59: 1095-101. (doi: 10.1007/s12630-012-9796-3).
• 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: 276-80. (doi: 10.1093/bja/aex166).
• Yamazaki H, Nishiyama J, Suzuki T. Use of perfusion index from pulse oximetry to determine efficacyof stellate ganglion block. Local Reg Anesth. 2012; 5: 9-14. (doi: 10.2147/LRA.S30257).
• Galvin EM, Niehof S, Verbrugge SJ et al. Peripheral flow index is a reliable and early indicator of regional block success. Anesth Analg 2006; 103: 239-43.
• Wenger A, Amr A, Schaller HE, Rothenberger J. Skin Perfusion Changes within 12 h after Axillary Plexus Block. Eur Surg Res. 2017; 58: 227-34. (doi: 10.1159/000475813).
• Sahin L, Gul R, Mizrak A, et al. Ultrasound-guided infraclavicular brachial plexus block enhances postoperative blood flow in arteriovenous fistulas. J Vasc Surg. 2011; 54: 749-53. (doi: 10.1016/j.jvs.2010.12.045).