Influence of gravitational sympathetic stimulation on the Surgical Plethysmographic Index

The perfusion index could early predict a nerve block success: A preliminary report

Introduction:

In literature, there is plenty of material regarding regional anesthesia techniques and block safety, but lacks about block success prevision. The perfusion index (PI) is an oximetry reliability indicator, available on many monitors as non-invasive parameter, indicating the ratio of arterial blood flow (pulsatile flow) to venous, capillary, and tissue blood flow (non-pulsatile blood flow). We hypothesized that that analysis of PI variations after performing regional anesthesia could have a role in predicting a successful nerve block.

Methods:

Twenty-four consecutive patients regularly scheduled for limb surgery in regional anesthesia were included in our observation. PI measurements were recorded before regional anesthesia, and 1, 2, 3, 5, and 10 min after needle withdrawal. Along with PI, also sensation to cold (ice test), tactile sensation, and motor function were recorded before regional anesthesia, and 1, 2, 3, 5, and 10 min after needle withdrawal on the limb where the block were performed.

Results:

Ten sciatic nerve blocks, 6 spinal anesthesia, 8 brachial plexus block were performed and resulted successful. In all cases, PI values tripled at 5 min after the block execution and increased linearly, reaching at 10 min an average PI value 3.8 times higher for the interscalene group, 4 times for the spinal group, and 8 for the sciatic group.

Conclusions:

A tripled PI within 5 min from performing regional anesthesia showed to be a reliable indicator of nerve block success, but a bigger trial involving more patients and different anesthetic concentrations may be necessary to confirm this assumption.