Changes in Vessels After Peripheral Block
Condition: Anesthesia, Local; Vena Cava Syndrome (Inferior) (Superior); Fluid Loss; Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Observational [Patient Registry]

Summary: 
      In patients with fluid deficit, vasoconstriction occurs in peripheral tissues and blood
      circulation is kept in the central area. It causes arterial vasodilation and hemodynamic
      variability by increasing the blood volume of the extremity due to the sympathectomy
      occurring after the block. When the investigators classify patients according to VCI-CI, it
      will be questioned whether there is a difference between patients' block quality and
      hemodynamic variability.
    

Detailed description: 
      VCI-CI helps us to have an idea about the amount of fluid in patients according to the vena
      cava Inferior (VCI) diameter and the diameter between the inspiring and expiration. Low
      arterial diameter and high inspiratory and expiratory variability indicate that the patient's
      fluid volume may be lower.

      In the measurement of VCI diameter, VCI has visualized in the craniocaudal plane thanks to
      the transverse ultrasound probe. Changes in VCI diameter are observed depending on the
      negative pressure in the thoracic area during inspiration and expiration. When the difference
      between this rate of change is greater than 50%, it indicates that the patient has a fluid
      deficit. The fact that the VCI diameter is also below 1.5 cm indicates that this amount of
      fluid requirement is more serious. In this study, the investigators will question whether
      there is a difference between patients' block quality and hemodynamic variability when they
      classify patients according to VCI-CI.
    

Intervention name(s): Lateral Sagittal Infraclavicular Block; Inferior vena cava diameter >1.5 cm and Vena Cava Inferior Collapsibility Index (VCI-CI) < 50%; Inferior vena cava diameter <1.5 cm and Vena Cava Inferior Collapsibility Index (VCI-CI) > 50%
Intervention type(s): Procedure; Procedure; Diagnostic Test
Intervention description(s): Patients will be in the supine position and after aseptic conditions are provided, the axillary artery of the patient will be visualized in the craniocaudal plane, in the infraclavicular region and in the lateral sagittal position with the help of an 8-12 mHz linear probe. After the brachial plexus cords around the axillary artery are identified, a local anesthetic mixture will be applied in-plane between the posterior cord and the artery. During the block, patients will routinely be given a mixture of 0.25% bupivacaine + 0.5% lidocaine 0.5 mL/kg.; While the patients are lying in the supine position, the vena cava will be determined 2 cm before the inferior heart entrance with the help of a 3.5-5 mHz convex probe. M-mode ECHO will be used to determine the fluctuation rate of the VCI between inspiration and expiration. After determining the farthest and closest points in M-mode ECO, their ratios to each other will be calculated.; While the patients are lying in the supine position, the vena cava will be determined 2 cm before the inferior heart entrance with the help of a 3.5-5 mHz convex probe. M-mode ECHO will be used to determine the fluctuation rate of the VCI between inspiration and expiration. After determining the farthest and closest points in M-mode ECO, their ratios to each other will be calculated.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Block differences will be observed when patients who undergo routine hand surgery
        operations under the lateral sagittal infraclavicular block are classified according to the
        Vena Cava Inferior - Collapsibility Index.
      
Keywords: Vena Cava Inferior Collapsibility Index; Lateral Sagittal Infraclavicular Block; VCI-CI