Use of perfusion index from pulse oximetry to determine efficacy of stellate ganglion block

Hajime Yamazaki, Junichi Nishiyama, Toshiyasu Suzuki, Hajime Yamazaki, Junichi Nishiyama, Toshiyasu Suzuki

Abstract

Background: Stellate ganglion block (SGB) is a widely used procedure for treatment of pain in the head and upper body, but the clinical signs used to verify the effectiveness of SGB can be ambiguous or variable in some patients. We observed the chronological changes in perfusion index (PI) from pulse oximetry to determine if these changes correlated with the clinical signs associated with an effective SGB. We hypothesized that PI could provide an easy method to assess the effectiveness of SGB.

Method: We compared the chronologies in PI on the treated and untreated sides of 21 patients in whom treatment by SGB was found to be effective. The SGB was performed by administering 6 mL of 1% mepivacaine. The effectiveness of the SGB was confirmed on the basis of clinical signs. Additionally, in two patients we tested whether increased PI on the treatment side correlated with increased microcirculation as measured by laser-Doppler blood flowmetry.

Results: On the side treated by SGB, PI increased 61.4% in the earlobe and 60.5% from baseline values in the upper limbs, at 5 minutes after initiation of the procedure. Differences in PI before and after treatment were significant at both sites. No time-course increases in PI were found on the untreated side at either site. Following SGB, increases in PI correlated with increases in blood flow as measured by laser-Doppler flowmetry.

Conclusion: PI increased in the earlobe and upper limbs on the treated side of 21 patients who received an effective SGB but not on the untreated side. The positive correlations between changes in PI and both presence of clinical signs and changes in blood flow in the skin microcirculation indicate a sympatholytic effect, suggesting that the PI could be useful in determination of the efficacy of SGB.

Keywords: perfusion index; peripheral perfusion; pulse oximetry; skin microcirculation; stellate ganglion block.

Figures

Figure 1
Figure 1
Chronological changes in PI in the earlobe. On the side of the SGB, 61.4% ± 50.5%, 84.0% ± 58.1%, 90.2% ± 62.1%, 115.8% ± 74.9%, 123.2% ± 83.8%, and 144.2% ± 74.1% increases were found at each respective time. No chronological changes were found on the opposite side of the SGB. Note:*P < 0.05 vs baseline; **P < 0.01 vs baseline. Abbreviations: SGB, stellate ganglion block; PI, perfusion index.
Figure 2
Figure 2
Chronological changes in PI in the upper limbs. On the side of the SGB, 60.5% ± 59.3%, 81.9% ± 68.9%, 87.3% ± 68.6%, 85.4% ± 67.5%, 61.0% ± 37.0%, and 57.6% ± 35.9% increases were found at each respective time. No chronological changes were found on the opposite side of the SGB. Note:**P < 0.01 vs baseline. Abbreviations: SGB, stellate ganglion block; PI, perfusion index.
Figure 3
Figure 3
Relationship between PI and blood flow after SGB, as measured by pulse oximetry and laser-Doppler blood flow meter sensor attached to the earlobes of 2 patients. (A) PI = 0.047 × (blood flow) – 0.968, r2 = 0.89, (B) PI = 0.025 × (blood flow) – 0.0531, r2 = 0.68. Abbreviations: SGB, stellate ganglion block; PI, perfusion index.
Figure 4
Figure 4
Chronological changes in PI in the upper limbs of a patient. The arrow indicates the time that SGB was performed. PI values on the side of the SGB increased chronologically, whereas those of the opposite side did not significantly following SGB. PI showed high frequency variations on both sides, but a time-course increase in PI was found only on the side of the SGB. Abbreviations: SGB, stellate ganglion block; PI, perfusion index.

References

    1. Matsumoto S. Thermographic assessments of the sympathetic blockade by stellate ganglion block (1) – Comparison between C7-SGB and C6-SGB in 40 patients. Masui. 1991;40(4):562–569.
    1. Matsumoto S. Thermographic assessments of the sympathetic blockade by stellate ganglion block (2) – Comparison and analysis of thermographic patterns between C7-SGB and C6-SGB in 20 healthy volunteers. Masui. 1991;40(5):692–701.
    1. Matsumoto S, Mitsuhata H, Hasegawa J. Thermographic assessments of the sympathetic blockade after stellate ganglion block (no 3) – the block at the base of the 6th cervical transverse process. Masui. 1992;41(1):111–118.
    1. Benzon H, Avram MJ. Temperature increases after complete sympathetic blockade. Reg Anesth. 1986;11(1):27–30.
    1. Malmqvist EL-Å, Bengtsson M, Sörensen J. Efficacy of stellate ganglion block: A clinical study with bupivacaine. Reg Anesth. 1992;17(6):340–347.
    1. Murakawa K, Noma K, Matsuda M, et al. Changes of tympanic temperature by stellate ganglion block in facial palsy. Facial N Res JPN. 1997;17:116–118.
    1. Stevens RA, Storz A, Kao T-C, Powar M, Burgess S, Kleinman B. The relative increase in skin temperature after stellate ganglion block is predictive of a complete sympathectomy of the hand. Reg Anesth Pain Med. 1998;23(3):266–270.
    1. Kapural L, Mekhail N. Assessment of sympathetic blocks. Tech Reg Anesth Pain Manage. 2001;5(3):82–87.
    1. Ebraheim NA, Lu J, Yang H, Heck BE, Yeasting RA. Vulnerability of the sympathetic trunk during the anterior approach to the lower cervical spine. Spine (Phila Pa 1976) 2000;25(13):1603–1606.
    1. Fukui T, Nakagawa G, Nishioka K, Fujioka Y, Okada Y. The study of anatomy of stellate ganglion in living human, and spread of injected solution by stellate ganglion block. Pain Clinic. 1993;14(2):226–231.
    1. Shibata Y, Fujiwara Y, Komatsu T. A new approach of ultrasound-guided stellate ganglion block. Anesth Analg. 2007;105(2):550–551.
    1. Wrete M. The anatomy of the sympathetic trunks in man. J Anat. 1959;93(4):448–459.
    1. Yamamuro M, Kaneko T. The comparison of stellate ganglion block at the transverse process of the 7th and the 6th cervical vertebra. Masui. 1978;27(4):376–389.
    1. Yamamuro M, Eba K, Kaneko T, Yasuda T, Hitsuda H, Ono K. Stellate ganglion block at the sixth cervical vertebra (2). A study of technique. Pain Clinic. 1991;12(4):507–512.
    1. Hogan QH, Erickson SJ, Haddox JD, Abram SE. The spread of solutions during stellate ganglion block. Reg Anesth. 1992;17(2):78–83.
    1. Honma M, Murakami G, Sato TJ, Namiki A. Spread of injectate during C6 stellate ganglion block and fascial arrangement in the prevertebral region: an experimental study using donated cadavers. Reg Anesth Pain Med. 2000;25(6):573–583.
    1. Elias M. Cervical sympathetic and stellate ganglion blocks. Pain Physician. 2000;3(3):294–304.
    1. Kaneko T, Date H, Yamamuro M. Spread of injectate during stellate ganglion block. Pain clinic. 2001;22(5):687–695.
    1. Berardesca E, Lévêque J-L, Masson P. EEMCO guidance for the measurement of skin microcirculation. Skin Pharmacol Appl Skin Physiol. 2002;15(6):442–456.
    1. Ozaki M, Sessler D, Lopez M, Walter K. Pulse oximeter-based flow index correlates well with finger volume plethysmography. Anesthesiology. 1993;79(3):A542.
    1. Murakawa K, Ishimoto E, Noma K, Ishida K, Nishijima M, Izumi R. Circulatory effects of stellate ganglion block in idiopathic facial palsy. Masui. 1994;43(3):356–360.
    1. Vegfors M, Tryggvason B, Sjöberg F, Lennmarken C. Assessment of peripheral blood flow using a pulse oximeter. J Clin Monit. 1990;6(1):1–4.
    1. Vegfors M, Lindberg L, Lennmarken C. The influence of changes in blood flow on the accuracy of pulse oximetry in humans. Acta Anaesthesiol Scand. 1992;36(4):346–349.
    1. Tenland T, Salerud EG, Nilsson GE, Öberg PA. Spatial and temporal variations in human skin blood flow. Int J Microcirc Clin Exp. 1983;2(2):81–90.
    1. Salerud EG, Tenland T, Nilsson GE, Öberg PA. Rhythmical variations in human skin blood flow. Int J Microcirc Clin Exp. 1983;2(2):91–102.

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