Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index: is it really an objective outcome?

Abstract Background: Pulse perfusion index (PI) is a reflection of blood perfusion. It has been reported that PI can be used to evaluate the effect of nerve block, but currently it is mostly focused on awake adults. In pediatric general anesthesia, it has been reported that PI can evaluate the effect of sacral block, but there is a lack of relevant research on the effect of brachial plexus blocks (BPB).Methods/Design: This is a mono-center, prospective, single-blinded, randomized controlled trial (RCT). 104 children aged 1 month to 12 years who undergo upper limb surgery will be enrolled in this study. According to anesthesia induction and maintenance medication, they will be divided into propofol group and sevoflurane group. Record the PI values of the index finger and little finger on the blocked and non-blocked sides of supraclavicular brachial plexus block (SCB) in all children. First, analyze the two groups of patients with complete blockage respectively, and observe whether the PI values of the index finger and the little finger have the same changes by comparing the baseline values. Secondly, the cases of failed or partial block will be analyzed to understand the relationship between the PI values of the index and little fingers. Thirdly, a comparative analysis of nerve block cases in the sevoflurane and propofol groups will find that PI in what kind of general anesthesia can better judge the effect of SCB in children. So as to provide a theoretical basis for PI to estimate the effect of SCB under general anesthesia in children.Discussion: After sevoflurane or propofol administration, changes in PI after BPB may exist in different situations at different periods. PI values in the blocked and non-blocked sides may vary with the metabolism of anesthetics. The surgery time is about 1h or so and the effects of nerve block still exist, so the PI value changes on the blocking side and the contralateral side can basically rule out the influence of general anesthetics on the PI value. Trial registration: ClinicalTrials.gov NCT04216823. Registered on 15 July, 2020.

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Pulse Oximeter Perfusion Index as a Predictor of Successful Supraclavicular Brachial Plexus Block

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0041-1734211 ◽

2021 ◽

Author(s):

Karthik S. L. ◽

Vishwanath Ankad ◽

Keyword(s):

Brachial Plexus ◽

Upper Limb ◽

Brachial Plexus Block ◽

Prospective Trial ◽

Perfusion Index ◽

Ultrasound Guided ◽

Study Objective ◽

Supraclavicular Brachial Plexus Block ◽

Supraclavicular Block ◽

Plexus Block

Abstract Objective Ultrasound-guided supraclavicular brachial plexus block is a popular anesthetic technique for upper limb surgeries. Assessing the success sensory and motor block using conventional methods is time consuming and also it needs patient co-operation. In the present study, objective method like increase in perfusion index is used to predict the success of ultrasound-guided supraclavicular block. Materials and Methods This prospective trial consists of total 95 patients undergoing elective upper limb procedures. All patients received ultrasound-guided supraclavicular block using 0.5% bupivacaine 20 mL. Sensory and motor blocks were evaluated every 5 minutes followed by pinprick testing and ability to flex the elbow and the hand against gravity, respectively. The perfusion index was measured using pulse oximetry applied on the index finger and recorded at baseline and 10, 20, and 30 minutes interval after local anesthetic injection in both the blocked limb and the contralateral unblocked limb using two separate pulse oximeters. Results Perfusion index increased in blocked arm after 5 minutes compared with unblocked arm and also to its baseline value. Both perfusion index and perfusion index ratio in blocked arm were found statistically significant. Conclusion To evaluate the success of supraclavicular block, perfusion index can be considered as a useful tool.

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DETECTION OF SUCCESSFUL SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK BY PULSE OXIMETER PERFUSION INDEX

10.36106/ijsr/4102010 ◽

2021 ◽

pp. 53-55

Author(s):

Ghosh Sujata ◽

Ray Manjushree ◽

Sarkar Arnab

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Block ◽

Thermal Sensation ◽

Perfusion Index ◽

Supraclavicular Approach ◽

Upper Limb Surgery ◽

Supraclavicular Brachial Plexus Block ◽

Index Ratio ◽

Plexus Block ◽

Improve Patient

Background: Early and accurate detection of failure of supraclavicular brachial plexus block helps to take early corrective measures and thus to save the operating room time and improve patient satisfaction. Aims: To assess the efcacy of perfusion index and perfusion index ratio in prediction of success or failure of brachial plexus block by supraclavicular approach. Methods: Ninety adult patients scheduled for upper limb surgery under supraclavicular brachial plexus block were recruited in this study. Success of brachial plexus was assessed by using traditional methods such as loss of pin prick and thermal sensation. Perfusion index and perfusion index ratio was monitored in both limbs at baseline, 3, 6, 9, 12, 15, 18 and, 21 minutes after block. Changes in PI and PI ratio were measured in successful as well as failure cases of brachial plexus block. Results: Signicant increase in perfusion index (1.60 Vs 7.65) and perfusion index ratio (1.00±0.00 Vs 4.78±2.7) was noticed following successful block. PI and PI ratio may be an important tool for early prediction of success rate of brachial plexus block. Failure or partial block was noticed in eight patients.

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