title: Does a digital regional nerve block improve the accuracy of noninvasive hemoglobin monitoring?
abstract: BACKGROUND
  Blood hemoglobin (Hb) can be continuously monitored utilizing noninvasive spectrophotometric finger sensors (Masimo SpHb). SpHb is not a consistently accurate guide to transfusion decisions when compared with laboratory Co-Oximetry (tHb). We evaluated whether a finger digital nerve block (DNB) would increase perfusion and, thereby, improve the accuracy of SpHb.
  
  
  METHODS
  Twenty adult patients undergoing spinal surgery received a DNB with lidocaine to the finger used for the monitoring of SpHb. SpHb-tHb differences were determined immediately following the DNB and approximately every hour thereafter. These differences were compared with those in our previously reported patients (N = 20) with no DNB. The SpHb-tHb difference was defined as "very accurate" if <0.5 g/dL and "inaccurate" if >2.0 g/dL. Perfusion index (PI) values at the time of each SpHb-tHb measurement were compared.
  
  
  RESULTS
  There were 57 and 78 data points in this and our previous study, respectively. The presence of a DNB resulted in 37 % of measurements having SpHb values in the "very accurate group" versus 12 % in patients without a DNB. When the PI value was >2.0, only 1 of 57 DNB values was in the "inaccurate" group. The PI values were both higher and less variable in the patients who received a DNB.
  
  
  CONCLUSIONS
  A DNB significantly increased the number of "very accurate" SpHb values and decreased the number of "inaccurate" values. We conclude that a DNB may facilitate the use of SpHb as a guide to transfusion decisions, particularly when the PI is >2.0.
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue, C317, San Francisco, CA 94143-0648, USA. MillerR@anesthesia.ucsf.edu
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Miller
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Ward
authors.forename: Charles E
authors.initials: CE
authors.lastname: McCulloch
authors.forename: Neal H
authors.initials: NH
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005385:Fingers; D006452:Hemoglobinometry / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009407:Nerve Block; D010092:Oximetry; D012039:Regional Blood Flow / Q000502:physiology; D015203:Reproducibility of Results