title: Peripheral flow index is a reliable and early indicator of regional block success.
abstract: We investigated the usefulness of peripheral flow index (PFI) measurement using a standard pulse oximetry digit probe for early prediction of successful regional blocks. Sixty-six patients scheduled for limb surgery underwent either axillary or sciatic block using a nerve stimulator technique with mepivacaine 1.5%. PFI, which is the ratio of the pulsatile versus the nonpulsatile component of the pulse oximetry signal, was recorded from 10 min before block insertion until 30 min afterwards. PFI recordings of the unblocked limb were similarly recorded. Pinprick and cold sensation were assessed at 5-min intervals until 30 min after blockade. An increase in PFI by a factor of 1.55 at 10 min after axillary block placement (P = 0.006), and 12 min after sciatic block placement (P = 0.001) was required to predict a successful block. The sensitivity and specificity of PFI was 100% for predicting axillary block outcomes at this time. Positive predictive value was 95% and negative predictive value was 93%. For sciatic blocks, sensitivity and specificity were 90% and 100%, respectively. The calculated positive predictive value at time 12 min for sciatic blocks was 94% and negative predictive value was 92%. At 15 min after block placement, cold and pinprick sensations had the same calculated values for sensitivity and specificity at 71% and 100%, respectively, for axillary blocks. For sciatic blocks, cold sensation had a sensitivity of 77% and a specificity of 100%, whereas pinprick had a sensitivity of just 20% with a specificity of 100%. We conclude that PFI provides a simple, early, and objective assessment of the success and failure of nerve blocks.
authors.affiliation: Department of Anesthesiology, Erasmus University Medical Center, 3015 GD, Rotterdam, The Netherlands. eilishgalvin@hotmail.com
authors.forename: Eilish M
authors.initials: EM
authors.lastname: Galvin
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Niehof
authors.forename: Serge Jc
authors.initials: SJ
authors.lastname: Verbrugge
authors.forename: Iscandar
authors.initials: I
authors.lastname: Maissan
authors.forename: Alexander
authors.initials: A
authors.lastname: Jahn
authors.forename: Jan
authors.initials: J
authors.lastname: Klein
authors.forename: Jasper
authors.initials: J
authors.lastname: van Bommel
mesh_terms: D000328:Adult; D000779:Anesthetics, Local; D001365:Axilla; D001783:Blood Flow Velocity; D005121:Extremities / Q000098:blood supply* / Q000294:innervation / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008619:Mepivacaine; D008875:Middle Aged; D009407:Nerve Block; D010092:Oximetry; D011237:Predictive Value of Tests; D011673:Pulsatile Flow; D012372:ROC Curve; D012584:Sciatic Nerve; D012677:Sensation; D012680:Sensitivity and Specificity
chemical_list: D000779:Anesthetics, Local; D008619:Mepivacaine