Perfusion index and USG for block assessment after infraclavicular block administration

In our study we aimed to compare the regional hemodynamic data measured with USG and the values of PI before and after block for variations occurring in extremity blood flow in patients administered infraclavicular block and to research their efficacy in assessing the success of block. The study included 40 patients administered infraclavicular block, aged from 18-65 years in ASA I-III risk group undergoing elective, unilateral, hand, wrist and elbow operations. In addition to basic hemodynamic measurements, a pulse oxymeter sensor was attached to the second finger on the operated upper extremity to perform PI measurements. The patient's other regional hemodynamic parameters were measured with doppler USG. Immediately before beginning the procedure, Doppler USG measurements were taken with sagittal scanning of the brachial artery 2-4 cm proximal of the anticubital fossa on the side of operation. The PSV, EDV, RI, TAV, BAA, BAD and BF values, starting sensory examination of the patient, pin-prick test results and PI values were recorded. After recording the initial values, lateral sagittal infraclavicular block was administered accompanied by USG and a nerve stimulator. The tip of the stimulation needle was inserted in the axillary artery at 6-8 o'clock position using the "in-plane" method accompanied by simultaneous imaging with the USG probe. For block, 200 mg lidocaine and 100 mg bupivacaine was used. After completing the block procedure (taking minute 0 as the time when the needle was removed from the skin), the SpO2, MAP, HR and PI, TAV, BAD, BAA, BF, PSV, EDV and RI values were recorded again in the 10th, 20th and 30th minutes. The duration of anesthesia settling was assessed with the pin-prick test, while anesthesia and motor block quality were assessed with the Holmenn scale simultaneously (0, 10th, 20th, 30th min). According to the Holmenn scale, patients with anesthesia quality and motor block quality each given points of at least 2 and with no additional analgesic requirements during the operation are accepted as having successful block. Patients with successful block in the first 10 minutes were assigned to Group A, while patients with block successful after the 10th minute were assigned to Group B. According to the Holmenn scale, in the 10th minute 27.5% of 40 patients, in the 20th minute 92.5% and in the 30th minute all patients had successful block observed. There were statistical differences observed for all regional hemodynamic data from the 10th minute on. When the regional hemodynamic data is compared between the groups in the 10th minute, there were differences identified for PI, BF, PSV, EDV and TAV. Within the measured parameters EDV was the parameter showing greatest proportional change. After EDV the greatest change was found for the PI value. Measured with spectral doppler USG and with least error depending on the person and location of measurement, the RI value was the parameter showing greatest proportional change after EDV and PI. In conclusion, it appeared that measurement of PI and regional hemodynamic data measured with spectral doppler USG were effective in assessing block success. It was concluded that variations in EDV, RI and PI especially provide more effective and objective results for the assessment of regional block success.