Change in pulse transit time in the lower extremity after lumbar sympathetic ganglion block: an early indicator of successful block

Joo, Eun Young; Kong, Yu Gyeong; Lee, Jonghyuk; Cho, Hyun‐Seok; Kim, Sung Hoon; Suh, Jeong Hun

doi:10.1177/0300060516681398

Cited by 8 publications

(10 citation statements)

References 25 publications

(48 reference statements)

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“…During different surgical procedures, various kinds of biosignals can be used to monitor abrupt physiological changes or to predict outcomes. PPG signals, in particular, can be used to reflect various physiological changes such as vascular compliance during hepatic graft reperfusion period following liver transplantation [ 29 ] and the success of lumbar sympathetic ganglion block [ 30 ]. There have been previous studies on the association between pulse transit time and BP.…”

Section: Discussionmentioning

confidence: 99%

Real-Time Monitoring of Blood Pressure Using Digitalized Pulse Arrival Time Calculation Technology for Prompt Detection of Sudden Hypertensive Episodes During Laryngeal Microsurgery: Retrospective Observational Study

et al. 2020

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Background Laryngeal microsurgery (LMS) is often accompanied by a sudden increase in blood pressure (BP) during surgery because of stimulation around the larynx. This sudden change in the hemodynamic status is not immediately reflected in a casual cuff-type measurement that takes intermittent readings every 3 to 5 min. Objective This study aimed to investigate the potential of pulse arrival time (PAT) as a marker for a BP surge, which usually occurs in patients undergoing LMS. Methods Intermittent measurements of BP and electrocardiogram (ECG) and photoplethysmogram (PPG) signals were recorded during LMS. PAT was defined as the interval between the R-peak on the ECG and the maximum slope on the PPG. Mean PAT values before and after BP increase were compared. PPG-related parameters and the correlations between changes in these variables were calculated. Results BP surged because of laryngoscopic manipulation (mean systolic BP [SBP] from 115.3, SD 21.4 mmHg, to 159.9, SD 25.2 mmHg; P<.001), whereas PAT decreased significantly (from mean 460.6, SD 51.9 ms, to 405.8, SD 50.1 ms; P<.001) in most of the cases. The change in SBP showed a significant correlation with the inverse of the PAT (r=0.582; P<.001). Receiver-operating characteristic curve analysis indicated that an increase of 11.5% in the inverse of the PAT could detect a 40% increase in SBP, and the area under the curve was 0.814. Conclusions During LMS, where invasive arterial catheterization is not always possible, PAT shows good correlation with SBP and may, therefore, have the potential to identify abrupt BP surges during laryngoscopic manipulations in a noninvasive manner.

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Section: Discussionmentioning

confidence: 99%

Real-Time Monitoring of Blood Pressure Using Digitalized Pulse Arrival Time Calculation Technology for Prompt Detection of Sudden Hypertensive Episodes During Laryngeal Microsurgery: Retrospective Observational Study

et al. 2020

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“…The pulse oxymetry was introduced to measure change in pulse transit time in the lower extremity, which had been considered as an early indicator of successful lumbar sympathetic block. 10 Skin conductance monitor was proved to indicate successful lumbar sympathetic block for all procedures. 27 Nevertheless, the pulse oxymetry and skin conductance monitor are restricted to single-point measurement and unable to quantify overall perfusion in the involved capillary bed.…”

Section: Discussionmentioning

confidence: 99%

“…4 5 The success of lumbar sympathetic block can be assessed by various measurements, such as laser Doppler perfusion imager, thermometry, infrared thermography, and pulse oximetry. [6][7][8][9][10] However, these tests are subject to poor temporal resolution and low spatial resolution because of long time intervals of data acquisition and limited observation field. Laser speckle contrast imaging (LSCI) is an optical imaging technique that allows real-time and full-field assessment of blood flow with high spatial and temporal resolution.…”

Section: Introductionmentioning

confidence: 99%

Predicting successful lumbar plexus block using blood flow index measured by laser speckle contrast imaging

Xiao-hu

et al. 2020

Preprint

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Background: Laser speckle contrast imaging (LSCI) is a powerful optical imaging technique for real-time and dynamic measurement of regional blood flow. The objective of this prospective observational study was to investigate blood flow changes after blockade of lumbar plexus or its three major branches respectively, with LSCI technique. Methods: This study included 47 adult patients scheduled for elective lower limb surgery. For the selective blockade of lumbar plexus, femoral nerve, obturator nerve, and lateral femoral cutaneous nerve, blood flow images and pinprick sensory scores of the blocked lower limb were recorded 5 min pre block and every 5 min for 30 min post block. Blood flow index (BFI) values of toes were calculated by LSCI software. Results: In this study, we have 21 cases of successful lumbar plexus blocks, 2 cases of failed lumbar plexus block, 8 cases of successful femoral nerve blocks, 8 cases of successful obturator nerve blocks, and 8 cases of successful lateral femoral cutaneous nerve blocks. The BFI values of all five toes were significantly increased as early as 5 min after successful lumbar plexus block, whereas no signiﬁcant difference was found in BFI values after failed lumbar plexus block. BFI changes after successful selective blockade of femoral nerve, obturator nerve, or lateral femoral cutaneous nerve were negligible. BFI value of the big toe at 5 min after the successful lumbar plexus block was increased by 2.57 fold compared with the baseline value, which represented the highest increase among five tested toes. BFI value of the big toe at 10 min after lumbar plexus block showed great power to predict block outcome with a sensitivity of 100% and a speciﬁcity of 100%. The optimal cut-off value given by ROC analysis was 22.11 PU. Conclusions: Increased blood flow index measured by laser speckle contrast imaging is a reliable indicator of successful lumbar plexus block, but cannot indicate successful selective blocks of three major branches of the lumbar plexus. BFI value of the big toe at 10 min after lumbar plexus block could well predict block outcome with the cut-off value of 22.11 PU.

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“…However, the variability of contrast spread may be subject to anatomic differences and/or secondary redistribution following injection [ 43 ] and an LSB under radioscopic guidance does not always ensure an exact performance. In order to evaluate the effect of an LSB, different methods are usually performed, including skin conductance response [ 39 , 44 ], laser Doppler flowmetry [ 45 ], skin plethysmography [ 46 , 47 ], perfusion index [ 48 ], skin temperature [ 49 , 50 ] and any combination of these methods.…”

Section: Introductionmentioning

confidence: 99%

Quantitative Analysis of Real-Time Infrared Thermography for the Assessment of Lumbar Sympathetic Blocks: A Preliminary Study

Cañada-Soriano

Priego-Quesada

Bovaira

et al. 2021

Sensors

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Lumbar sympathetic blocks (LSBs) are commonly performed to treat pain ailments in the lower limbs. LSBs involve injecting local anesthetic around the nerves. The injection is guided by fluoroscopy which is sometimes considered to be insufficiently accurate. The main aim was to analyze the plantar foot skin temperature data acquired while performing LSBs in patients with complex regional pain syndrome (CRPS) affecting the lower limbs. Forty-four LSBs for treating lower limb CRPS in 13 patients were assessed. Pain medicine physicians visualized the infrared thermography (IRT) video in real time and classified the performance depending on the observed thermal changes within the first 4 min. Thirty-two percent of the cases did not register temperature variations after lidocaine was injected, requiring the needle to be relocated. Differences between moments are indicated using the 95% confidence intervals of the differences (CI 95%), the Cohen effect size (ES) and the significance (p value). In successful cases, after injecting lidocaine, increases at minute 7 for the mean (CI 95% (1.4, 2.1 °C), p < 0.001 and ES = 0.5), at minute 5 for maximum temperature (CI 95% (2.3, 3.3 °C), p < 0.001 and ES = 0.6) and at minute 6 for SD (CI 95% (0.2, 0.3 °C), p < 0.001 and ES = 0.5) were observed. The results of our preliminary study showed that the measurement of skin temperature in real time by infrared thermography is valuable for assessing the success of lumbar sympathetic blocks.

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Change in pulse transit time in the lower extremity after lumbar sympathetic ganglion block: an early indicator of successful block

Cited by 8 publications

References 25 publications

Real-Time Monitoring of Blood Pressure Using Digitalized Pulse Arrival Time Calculation Technology for Prompt Detection of Sudden Hypertensive Episodes During Laryngeal Microsurgery: Retrospective Observational Study

Real-Time Monitoring of Blood Pressure Using Digitalized Pulse Arrival Time Calculation Technology for Prompt Detection of Sudden Hypertensive Episodes During Laryngeal Microsurgery: Retrospective Observational Study

Predicting successful lumbar plexus block using blood flow index measured by laser speckle contrast imaging

Quantitative Analysis of Real-Time Infrared Thermography for the Assessment of Lumbar Sympathetic Blocks: A Preliminary Study

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