Regional haemodynamic variables and perfusion index in the evaluation of sciatic nerve block: a prospective observational trial

Abstract

ObjectiveWe determined whether regional haemodynamics and perfusion index (PI) could be reliable indicators of a successful sciatic nerve block (SNB).DesignProspective observational trial.SettingA tertiary teaching hospital in China from April 2020 to August 2020.ParticipantsWe assessed 79 patients for eligibility to participate in this study. Nine patients were excluded for not meeting our inclusion criteria, and three patients were excluded due to missing measurements at all time points.InterventionsThe patients underwent SNB. Pulsed-wave Doppler and PI measurements were performed.Primary and secondary outcome measuresThe primary outcome measure was the diagnostic power of regional haemodynamic change and PI to predict successful SNB. The secondary outcome measure was the effect of SNB on the regional haemodynamics and PI in the lower extremity.ResultsWe assessed 79 patients in this study and 67 patients available for the final analysis. The SNB was successful in 59 patients and failed in eight patients. There were no significant differences in demographic characteristics between the patients with successful and failed SNB. Starting from 10 min after SNB, the peak systolic velocity (PSV), end-diastolic velocity, time-averaged maximum velocity and time-averaged mean velocity of the anterior tibial artery and posterior tibial artery of patients in the successful SNB group were significantly higher than those in the failed SNB group (p<0.05). The PSV percentage increase at 10 min after SNB has great potential to predict the block success. The area under the receiver operating characteristic curve (AUC) values were 0.893 (95% CI 0.7809 to 1.000) and 0.880 (95% CI 0.7901 to 0.9699). The corresponding cut-off values were 19.22 and 35.88, respectively. The PI increased during 5–45 min intervals in patients with successful SNB. The AUC for the PI percentage increases at 10 min after SNB was 0.853 (95% CI 0.7035 to 1.000), with a cut-off value of 93.09.ConclusionThe regional haemodynamic variables, PSV and PI in particular, can be used as alternative indicators for clinicians to evaluate the success of SNB objectively and early.Trial registration numberChiCTR2000030772.

Serial Peripheral Nerve Blocks to Aid in Salvage of a Compromised Limb: A Case Report

“…In retrospect, objective measures of improved perfusion from PNB could have been obtained in this case, such as the calculation of perfusion index. 10,11…”

“…cases-anesthesia-analgesia.org a & a pRaCtICe perfusion from PNB could have been obtained in this case, such as the calculation of perfusion index. 10,11 Use of PNB in this patient provided the dual benefits of vasodilation and improved pain control, which decreased the need for analgesic adjuncts as well as improved patient mobility, participation in physical therapy, and hemodynamic stability. Conversely, complications of PNB were seriously considered, including the chance of nerve injury, infection, bleeding risk, and local anesthetic systemic toxicity.…”

Investigation of infraclavicular block success using the perfusion index: a randomized clinical trial

“…Available data demonstrate that PI is a sensitive parameter to express the vasomotor tone loss induced by LAs. Therefore, PI can be considered an objective measure of peripheral perfusion, which can predict the success of peripheral block [ 11 ]. In our study, the PI values measured in the extremity in which the block was induced at 5 min were significantly higher than those measured before the block induction.…”

“…Thus, PI is considered an objective measure for predicting the peripheral block success. The efficacy of PI in predicting the peripheral block success has been demonstrated in BP blocks [ 11 , 15 ], axillary BP blocks [ 13 ], interscalene BP blocks [ 12 ], sciatic nerve blocks [ 14 ], and supraclavicular BP blocks [ 16 ]. Of these studies, Kuş et al [ 15 ] showed that PI, a measure of peripheral perfusion, was a reliable and objective method for assessing the efficacy of infraclavicular blockade, but they did not report any cutoff value for PI.…”

Regional Blood Flow Spectral Parameters as Predictors of Epidural-Related Maternal Fever: A Prospective Observational Study

“…Eicke et al have demonstrated that Doppler ultrasound can quantify sympathetically induced changes in peripheral vascular resistance 6 . Prior studies have utilized regional hemodynamic parameters to evaluate the e cacy of peripheral nerve blocks based on this mechanism 7,8 . Acquisition of an objective ultrasoundbased indicator will assist clinicians in identifying individuals at risk for ERMF early.…”