Perfusion Index and Pleth Variability Index an Early Indicator of the Success of Brachial Plexus Block; Randomized Clinical Triall
Condition: Perfusion Index and Pleth Variability Index an Early Indicator of the Success of Brachial Plexus Block; Randomized Clinical Trial
Study type: Observational

Summary: 
      Abstract:

      Background: In investigators study, we aimed to compare PI and PVI between the interscalen
      block and infraclavicular block and evaluate its use as an early marker in block success.

      Meterial- Methods: 40 patients, including ASA1-2, 20 patients over the age of 18, who were
      planned for upper extremity surgery, in the interscalen group, and 20 in the supraclavicular
      group, were included in the study. Demographic data of the patients were recorded by
      measuring PI and PVI values at baseline before the block and at the 1st, 5th, 10th, 15th, and
      20th minutes after the block, both simultaneously.
    

Detailed description: 
      investigators study, which was designed as a prospective clinical study, was initiated in
      accordance with the according to the consort flow diagram, after the approval of the clinical
      research ethics committee of Malatya Turgut Özal University, dated 03.08.2021 and numbered
      2021/43. investigators study was carried out in accordance with the Helsinki declaration
      published in 2013.The patients were randomly divided into two groups as the patients who
      underwent interscalen block (ISB) and infraclavicular block (ICB) by the closed-envelope
      method by a blind nurse who did not participate in the study. Based on similar studies, the
      sample size of the study was calculated as 0.05 patients with alpha and 0.8 patients with a
      beta, 20 patients in each group, a total of 40 patients. 46 patients over the age of 18 with
      ASA classification (American Society of Anesthesiologists) I-II, who were planned to undergo
      upper extremity surgery, were included in the study. 6 patients were excluded from the study
      because they were switched to general anesthesia, and 40 patients who developed successful
      block were included in the study. Pediatric patients, pregnant patients, patients with
      peripheral arterial disease, heart failure with a hemoglobin level of 10, renal failure,
      liver failure, coagulation disorder with neuropathy, and patients with known allergy to local
      anesthetics were excluded from the study. Wet signed informed consent was obtained from all
      patients.

      All patients included in the study were examined by an anesthesiologist before anesthesia.
      Following the appropriate fasting period, the patients were taken to the preparation room and
      routine monitoring (peripheral oxygen saturation, non-invasive arterial measurement of blood
      pressure and Electrocardiogram) were performed. Vascular access was established with a 20G
      branule in the other arm, which did not undergo surgery. The patients were administered
      midazolam (0.05-0.1 mg/kg, Dormicum 5mg/5cc, Deva İlaç, Istanbul) for sedation before the
      procedure. Nasal oxygen was given at 2-4 L/min. In addition to routine monitoring, both upper
      extremities Perfusion index: PI, Plethysmographic variability index: PVI, hemoglobin HGB,
      (The probe of a MasimoRadical 7, MasimoCorp. Irvine, CA, USA) were performed. Using an
      insulated neurostimulation needle (22 G, 50 mm Locoplex, Vygon®, France) accompanied by USG
      (Samsung HM70 Evo, South Korea) and nerve stimulator (Stimuplex, HNS 11; Braun Melsunçgen,
      Melsungen, Germany) Interscalen block was performed in 20 patients and the infraclavicular
      block were performed in 20 patients. After turning the head to the opposite side of the
      patients in the interscalen group, a skin anti setting was provided with povidone-iodine in
      the treatment area. The USG probe was placed transversely obliquely from the level of the
      cricoid cartilage (C6) to the line connecting the interscalen space and the brachial plexus
      was found and 22G 50 mm insulated nerve stimulator needle was inserted in-plain with a
      posterior approach and 10 mL of 0.5% bupivacaine, 10 mL of 2% lidocaine, 10 mL of 2%
      prilocaine were injected considering the loss of response at currents less than 0.2-0.3 mA to
      avoid the risk of intraneural injection after a distal motor response was found at <0.5 mA
      with a nerve stimulator. In the infraclavicular group, after the area was cleaned with
      povidone-iodine, the USG probe was placed in the area where the clavicle and the cricoid
      process intersect, and the anatomical structure was observed. A 22G 50 mm stimulator needle
      was inserted with the in-plain approach, and after the distal motor response was found at <
      0.5 mA with the nerve stimulator, to avoid the risk of intraneural injection, considering the
      loss of response at currents less than 0.2-0.3 mA, 10 mL % 0.5 bupivacaine, 10 ml 2%
      lidocaine, 10 ml 2% prilocaine injections were administered. The development of sensorineural
      block (inability to identify the cold application) in the motor block and related dermatomes
      was accepted as a successful block.

      Demographic data such as age, gender, height, weight, and body mass index (BMI) of the
      patients and entry hemoglobin levels were recorded. Heart rate per minute (HR) systolic blood
      pressure (SAP) diastolic blood pressure (DAP) peripheral oxygen saturation (SpO2) and
      simultaneous block and contralateral Perfusion index: PI, Plethysmographic index of
      variability: PVI values were recorded by measuring baseline, post-block 1st, 5th, 10th, 15th,
      and 20th values. After the measurements, the patients with successful block were presented to
      surgery. Patients without complications after surgery were transferred to the service.
    

Intervention name(s): INTERSCALEN BLOCK APPLICATION WITH USG
Intervention type(s): Other
Intervention description(s): 40 patients, including ASA1-2, 20 patients over the age of 18, who were planned for upper extremity surgery, in the interscalen group, and 20 in the supraclavicular group, were included in the study. Demographic data of the patients were recorded by measuring PI and PVI values at baseline before the block and at the 1st, 5th, 10th, 15th, and 20th minutes after the block, both simultaneously.
Other intervention name(s): SHOULDER SURGERY
Sampling method: Probability Sample
Study population: 
        patients who will undergo upper-term surgery
      
Keywords: brachial plexus; interscalene block; infraclavicular block; Perfusion index; Pleth Variability Index; regional anesthesia