The ability of perfusion index to detect segmental ulnar nerve sparing after supraclavicular nerve block
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ORIGINAL RESEARCH
The ability of perfusion index to detect segmental ulnar nerve sparing after supraclavicular nerve block Bassant Abdelhamid1 · Mohamed Emam1 · Maha Mostafa1 · Ahmed Hasanin1 · Wael Awada1,2 · Ashraf Rady1 · Heba Omar1 Received: 26 August 2019 / Accepted: 1 December 2019 © Springer Nature B.V. 2019
Abstract Supraclavicular nerve block (SCB) is a commonly used regional block for upper extremity surgery. The most common form of failure of SCB is ulnar segmental sparing. We aimed to evaluate the accuracy of perfusion index (PI) in early detection of segmental sparing of the ulnar component of SCB. A prospective observational study included adult patients scheduled for surgery under ultrasound-guided SCB. PI was simultaneously measured at the index finger and little finger. PI was recorded every minute for the first 10 min after SCB. PI ratio was calculated at every measurement point as PI/baseline PI. The area under the receiver operating characteristic (AUROC) curve was calculated for the ability of PI ratio to detect segmental ulnar sparing with comparison of little finger readings to the index finger readings. Forty-nine patients were available for the final analysis. Nine patients (18%) had segmental ulnar sparing. PI ratio at the little finger showed excellent predictive ability for ulnar sparing starting from the fifth minute (AUROC 0.92 [0.8–0.98], cutoff value ≤ 1.71) and reached the highest value at the seventh minute (AUROC 0.96 [0.86–1], cutoff value ≤ 1.35), whereas PI ratio at the index finger showed poor predictive ability. When using the PI for evaluation of successful SCB, segmental ulnar sparing could be accurately detected when the PI was measured at the little finger and not at the index finger. An increase of 71% in PI at the little finger 5 min after SCB could accurately rule out ulnar sparing. Clinical trial identifier NCT03880201. Clinical trial registration https://clinicaltr ials.gov/ct2/show/NCT0388020 1?term=NCT03880201&draw=2&rank=1. Keywords Masimo pulse oximetry · Perfusion index · Perfusion index ratio · Supraclavicular nerve block · Ulnar nerve sparing
1 Introduction Supraclavicular nerve block (SCB) is one of the commonly performed peripheral nerve blocks for upper extremity operations [1]. Blocking the brachial plexus through the supraclavicular approach has the advantage of single-puncture
technique because of the tight location of the plexus elements at this location [1]. These anatomical characteristics are also responsible for the rapid onset and the high success rate of the SCB especially after introduction of ultrasound guidance; however, sparing of some segments after SCB is a known mishap, which delays the operation and stresses the
* Ahmed Hasanin [email protected]
Ashraf Rady [email protected]
Bassant Abdelhamid [email protected]
Heba Omar [email protected]
Mohamed Emam [email protected]
1
Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, C01 Elsarayah Street
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