Evaluation of prediction effect of perfusion index for supraclavicular brachial plexus block in children: protocol for a randomized trial

Jinxu Wang, Lingli Deng, Aijun Xu, Jinxu Wang, Lingli Deng, Aijun Xu

Abstract

Background: Pulse perfusion index (PI) reflects blood perfusion. It has been reported that PI can be used to evaluate the effect of nerve block, but currently, it is mainly focused on awake adults. In pediatric general anesthesia, it has been reported that PI can evaluate the effect of the sacral block. Still, there is a lack of relevant research on the impact of brachial plexus blocks. Our objective is to assess the prediction effects of PI on the success of supraclavicular brachial plexus block in pediatric patients under sevoflurane or propofol general anesthesia.

Methods/design: This is a mono-center, parallel, 2-arm randomized superiority trial. One hundred four children aged 1 month to 12 years who undergo upper limb surgery will be enrolled in this study. According to anesthesia induction and maintenance medication, they will be divided into sevoflurane and propofol groups. The PI values of the index and little finger will be recorded on the blocked and non-blocked sides of supraclavicular brachial plexus block (SCB) in all children. The primary outcome is to assess the effects of PI on the success of supraclavicular brachial plexus block in pediatric patients under sevoflurane or propofol general anesthesia. The secondary outcome includes mean arterial blood pressure (MAP), heart rate (HR), and correlation between baseline PI and 10 min after SCB (PI ratio).

Discussion: This trial will provide evidence on the changes in PI after SCB in sevoflurane or propofol anesthesia in children. SCB may lead to changes in PI values under sevoflurane or propofol anesthesia. After the children wake up at the end of the surgery, the changes in PI values on the block side and non-block side may be helpful to judge the effect of nerve block when excluding the influence of anesthetics.

Trial registration: ClinicalTrials.gov NCT04216823 . Registered on 15 July 2020.

Keywords: Anesthesia; Pediatric; Perfusion Index; Supraclavicular brachial plexus block.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of this study
Fig. 2
Fig. 2
Participant timeline

References

    1. Boutis K. The emergency evaluation and management of pediatric extremity fractures. Emerg Med Clin North Am. 2020;38(1):31–59. doi: 10.1016/j.emc.2019.09.003.
    1. Naranje SM, Erali RA, Warner WC, Jr, Sawyer JR, Kelly DM. Epidemiology of pediatric fractures presenting to emergency departments in the United States. J Pediatr Orthop. 2016;36(4):e45–e48. doi: 10.1097/BPO.0000000000000595.
    1. Merckaert S, Chaibi E, Meriem S, Kwiatkowski B, Divjak N, Zambelli PY. Epidemiology of pediatric upper extremity fractures in tertiary care center in Switzerland. Pediatr Emerg Care. 2021;37(12):e825-e835.
    1. Bruce BG, Green A, Blaine TA, Wesner LV. Brachial plexus blocks for upper extremity orthopedic surgery. J Am Acad Orthop Surg. 2012;20(1):38–47. doi: 10.5435/00124635-201201000-00005.
    1. Zadrazil M, Opfermann P, Marhofer P, Westerlund AI, Haider T. Brachial plexus block with ultrasound guidance for upper-limb trauma surgery in children: a retrospective cohort study of 565 cases. Br J Anaesth. 2020;125(1):104–109. doi: 10.1016/j.bja.2020.03.012.
    1. Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney CJ, Franco CD, Hogan QH. Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med. 2009;34(2):134–170. doi: 10.1097/AAP.0b013e31819624eb.
    1. Klaastad O, Sauter AR, Dodgson MS. Brachial plexus block with or without ultrasound guidance. Curr Opin Anaesthesiol. 2009;22(5):655–660. doi: 10.1097/ACO.0b013e32832eb7d3.
    1. Hanumanthaiah D, Vaidyanathan S, Garstka M, Szucs S, Iohom G. Ultrasound-guided supraclavicular block. Med Ultrason. 2013;15(3):224–229. doi: 10.11152/mu.2013.2066.153.dh1mg2.
    1. De José MB, Banús E, Navarro Egea M, Serrano S, Perelló M, Mabrok M. Ultrasound-guided supraclavicular vs infraclavicular brachial plexus blocks in children. Paediatr Anaesth. 2008;18(9):838–844. doi: 10.1111/j.1460-9592.2008.02644.x.
    1. Amiri HR, Espandar R. Upper extremity surgery in younger children under ultrasound-guided supraclavicular brachial plexus block: a case series. J Child Orthop. 2011;5(1):5–9. doi: 10.1007/s11832-010-0264-8.
    1. Wu JP. Pediatric anesthesia concerns and management for orthopedic procedures. Pediatr Clin North Am. 2020;67(1):71–84. doi: 10.1016/j.pcl.2019.09.006.
    1. Walker BJ, Long JB, Sathyamoorthy M, Birstler J, Wolf C, Bosenberg AT, Flack SH, Krane EJ, Sethna NF, Suresh S, et al. Complications in pediatric regional anesthesia: an analysis of more than 100,000 blocks from the pediatric regional anesthesia network. Anesthesiology. 2018;129(4):721–732. doi: 10.1097/ALN.0000000000002372.
    1. Abdelnasser A, Abdelhamid B, Elsonbaty A, Hasnain A, Rady A. Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index. Br J Anaesth. 2017;119(2):276–280. doi: 10.1093/bja/aex166.
    1. Piasek CZ, Van Bel F, Sola A. Perfusion index in newborn infants: a noninvasive tool for neonatal monitoring. Acta Paediatr (Oslo, Norway : 1992) 2014;103(5):468–473. doi: 10.1111/apa.12574.
    1. Abdelhamid B, Emam M, Mostafa M, Hasnain A, Awada W, Rady A, Omar H. The ability of perfusion index to detect segmental ulnar nerve-sparing after supraclavicular nerve block. J Clin Monit Comput. 2020;34(6):1185–1191. doi: 10.1007/s10877-019-00443-4.
    1. Kus A, Gurkan Y, Gormus SK, Solak M, Toker K. Usefulness of perfusion index to detect the effect of brachial plexus block. J Clin Monit Comput. 2013;27(3):325–328. doi: 10.1007/s10877-013-9439-4.
    1. Kim D, Jeong JS, Park MJ, Ko JS. The effect of epinephrine on the perfusion index during ultrasound-guided supraclavicular brachial plexus block: a randomized controlled trial. Sci Rep. 2020;10(1):11585. doi: 10.1038/s41598-020-68475-4.
    1. Xu Z, Zhang J, Shen H, Zheng J. Assessment of pulse oximeter perfusion index in pediatric caudal block under basal ketamine anesthesia. ScientificWorldJournal. 2013;2013:183493.
    1. Sebastiani A, Philippi L, Boehme S, Closhen D, Schmidtmann I, Scherhag A, Markstaller K, Engelhard K, Pestel G. Perfusion index and plethysmographic variability index in patients with interscalene nerve catheters. Can J Anaesth. 2012;59(12):1095–1101. doi: 10.1007/s12630-012-9796-3.
    1. Yamazaki H, Nishiyama J, Suzuki T. Use of perfusion index from pulse oximetry to determine efficacy of stellate ganglion block. Local Reg Anesth. 2012;5:9–14. doi: 10.2147/LRA.S30257.
    1. Gurnaney H, Ganesh A, Cucchiaro G. The relationship between current intensity for nerve stimulation and success of peripheral nerve blocks performed in pediatric patients under general anesthesia. Anesth Analg. 2007;105(6):1605–1609. doi: 10.1213/01.ane.0000287642.21534.ed.
    1. Öksüz G, Arslan M, Urfalıoğlu A, Güler AG, Tekşen Ş, Bilal B, Öksüz H. Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial. Reg Anesth Pain Med. 2020;45(3):187–191. doi: 10.1136/rapm-2019-101027.
    1. Kuratani N, Oi Y. Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane: a meta-analysis of randomized controlled trials. Anesthesiology. 2008;109(2):225–232. doi: 10.1097/ALN.0b013e31817f5c18.
    1. Zeeni C, Karam CJ, Kaddoum RN, Aouad MT. Propofol use in children: updates and controversies. Minerva Anestesiol. 2020;86(4):433–444. doi: 10.23736/S0375-9393.19.14022-9.
    1. Park SG, Lee OH, Park YH, Shin HY, Kang H, Baek CW, Jung YH, Woo YC. The changes of non-invasive hemoglobin and perfusion index of Pulse CO-Oximetry during induction of general anesthesia. Korean J Anesthesiol. 2015;68(4):352–357. doi: 10.4097/kjae.2015.68.4.352.

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