Skin Perfusion Changes within 12 h after Axillary Plexus Block

Abstract

Background/Purpose: An improvement of the blood flow would be beneficial in microvascular upper-extremity reconstruction and in digit replantation. In the present work, skin perfusion changes and their duration due to axillary plexus block were quantified. Methods: The peripheral blood flow of the upper extremities in 20 patients undergoing trapeziectomy under axillary plexus block was analyzed. Results: Laser Doppler spectrophotometry was used to measure perfusion factors over a 12-h period, with the contralateral hand acting as the control. Axillary plexus block produced a significant increase of peripheral oxygen saturation (117 ± 35% vs. control 93 ± 22%, p = 0.019), peripheral blood flow (220 ± 166% vs. 130 ± 77%, p = 0.037), and velocity (164 ± 58% vs. 117 ± 45%, p = 0.011). Conclusion: Axillary plexus block produces an improvement of peripheral tissue oxygen saturation of the upper extremities over the first 6 h after the inception of anesthesia. This suggests a potential benefit especially for critically perfused tissues.

Improvement of Superficial and Deep Cutaneous Microcirculation Due to Axillary Plexus Anesthesia Impaired by Smoking

“…Our results are in line with previous work from Wenger et al, who conducted a prospective analysis of the effects of regional anesthesia on cutaneous microcirculation [ 5 , 6 ]. Whereas their investigation focused on the quantification and course of the elicited effects, our goal was to analyze acute effects within different tissue layers and, therefore, different vascular territories.…”

“…The German Speaking Society for Microsurgery of Peripheral Nerves and Vessels recommends the utilization of regional anesthesia techniques in the context of microsurgical reconstructive procedures according to an expert opinion-based consensus statement [ 2 , 3 ]. Derived from the available literature, it is commonly accepted that regional anesthesia has a beneficial influence on perfusion dynamics as well as on local microcirculation [ 4 , 5 , 6 ]. However, despite earlier publications already acknowledging the benefits of regional anesthesia in the context of microsurgical interventions, such as digital replantation, there is only limited evidence available from clinical trials with an emphasis on its effects on free flap perfusion and specifically, microcirculatory characteristics [ 7 , 8 , 9 ].…”

“…In previous works, Wenger et al demonstrated the vasodilatory effects of axillary plexus blockage with enhanced microcirculation regarding blood flow and tissue oxygenation of the finger pulp prior to scheduled hand surgery [ 6 ]. Continued postoperative measurements also showed a sustained improvement in microcirculatory parameters for at least 6 h after inception of the anesthesia [ 5 ].…”

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

“…Abdelnasser et al [13] reported that PI may be useful in determining the success of a supraclavicular blockade in patients undergoing orthopedic surgery. Wenger A et al [16] suggested that a brachial plexus blockade should be used especially where perfusion is important, in that the increase in skin perfusion remains for 6-12 hours after the brachial plexus blockade. In a study by Han-Hsiang Su et al [2], a continuous brachial plexus blockade was found to be effective in maintaining the continuity of grafts after a microsurgical implantation.…”

Assessing the Safety and Efficacy of Regional Anesthesia for Lower Extremity Microvascular Reconstruction: Enhancing Recovery

“…The sympathicolytic effects produced by pain catheters coupled with limb analgesia to increase tissue perfusion have been previously described. 6 The delicate nature of microvascular anastomoses requires meticulous control of pain and sympathetic physiology, though to date, the role of perineural infusion in the lower extremity free flap has been undefined. PACU flap management revolves around achieving normothermia, stable or even increased cardiac output, and adequate urine output to maximize perfusion.…”