Quantification of the vasodilatory effect of axillary plexus block. A prospective controlled study

Wenger, Andrea; Rothenberger, Jens; Hakim‐Meibodi, Lara‐Elena; Notheisen, Thomas; Schaller, Hans-Eberhard

doi:10.1016/j.jss.2017.01.009

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…Our results are in line with previous work from Wenger et al, who conducted a prospective analysis of the effects of regional anesthesia on cutaneous microcirculation [ 5 , 6 ]. Whereas their investigation focused on the quantification and course of the elicited effects, our goal was to analyze acute effects within different tissue layers and, therefore, different vascular territories.…”

Section: Discussionsupporting

confidence: 93%

“…Furthermore, the authors concluded that full blockage of the sympathetic vasoconstrictive transmission requires a higher concentration than complete sensory blockade. Based on the results published by Wenger et al, the more pronounced changes in cutaneous blood flow in our current study might be the result of the different composition of the anesthetic agents utilized as well [ 6 ].…”

Section: Discussionmentioning

confidence: 71%

“…The German Speaking Society for Microsurgery of Peripheral Nerves and Vessels recommends the utilization of regional anesthesia techniques in the context of microsurgical reconstructive procedures according to an expert opinion-based consensus statement [ 2 , 3 ]. Derived from the available literature, it is commonly accepted that regional anesthesia has a beneficial influence on perfusion dynamics as well as on local microcirculation [ 4 , 5 , 6 ]. However, despite earlier publications already acknowledging the benefits of regional anesthesia in the context of microsurgical interventions, such as digital replantation, there is only limited evidence available from clinical trials with an emphasis on its effects on free flap perfusion and specifically, microcirculatory characteristics [ 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Reduced vascular tone due to sympathetic blockade, which otherwise represents one major vasoconstrictive agent, may also reduce vasospasm of microvessels and transplanted tissues. In previous works, Wenger et al demonstrated the vasodilatory effects of axillary plexus blockage with enhanced microcirculation regarding blood flow and tissue oxygenation of the finger pulp prior to scheduled hand surgery [ 6 ]. Continued postoperative measurements also showed a sustained improvement in microcirculatory parameters for at least 6 h after inception of the anesthesia [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Improvement of Superficial and Deep Cutaneous Microcirculation Due to Axillary Plexus Anesthesia Impaired by Smoking

Bosselmann

Kolbenschlag

Goertz

et al. 2021

JCM

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Background: Understanding microvascular physiology is key to any reconstructive procedure. Current concepts in anesthesia increasingly involve regional peripheral nerve blockade during microvascular reconstructive procedures. Whereas favorable effects on perfusion due to these techniques have been reported earlier, little evidence focusing on its effects in most peripheral vascular compartments is available. Methods: A total of 30 patients who were to receive axillary plexus blockade (APB) were included. Microcirculatory assessment of the dependent extremity was conducted utilizing combined laser-Doppler flowmetry and white light spectroscopy. Two probes (1–2 and 7–8 mm penetration depth) were used to assess changes in microcirculation. Results: APB resulted in significant changes to both superficial and deep cutaneous microcirculation. Changes in blood flow were most prominent in superficial layers with a maximum increase of +617% compared to baseline values. Significantly lower values of +292% were observed in deep measurements. Consecutively, a significant enhancement in tissue oxygen saturation was observed. Further analysis revealed a significant impairment of perfusion characteristics due to reported nicotine consumption (max Bf: +936% vs. +176%). Conclusion: Cutaneous microcirculation is strongly affected by APB, with significant differences regarding microvascular anatomy and vascular physiology. Smoking significantly diminishes the elicited improvements in perfusion. Our findings could influence reconstructive strategies as well as dependent perioperative anesthetic management.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Improvement of Superficial and Deep Cutaneous Microcirculation Due to Axillary Plexus Anesthesia Impaired by Smoking

Bosselmann

Kolbenschlag

Goertz

et al. 2021

JCM

View full text Add to dashboard Cite

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“…In a previous work, we have already shown the acute vasodilatory effect of axillary block [13]. However, a long-lasting improvement of the blood flow due to plexus block would be beneficial in microvascular upper extremity reconstruction and in digit replantation.…”

Section: Introductionmentioning

confidence: 99%

Skin Perfusion Changes within 12 h after Axillary Plexus Block

et al. 2017

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Background/Purpose: An improvement of the blood flow would be beneficial in microvascular upper-extremity reconstruction and in digit replantation. In the present work, skin perfusion changes and their duration due to axillary plexus block were quantified. Methods: The peripheral blood flow of the upper extremities in 20 patients undergoing trapeziectomy under axillary plexus block was analyzed. Results: Laser Doppler spectrophotometry was used to measure perfusion factors over a 12-h period, with the contralateral hand acting as the control. Axillary plexus block produced a significant increase of peripheral oxygen saturation (117 ± 35% vs. control 93 ± 22%, p = 0.019), peripheral blood flow (220 ± 166% vs. 130 ± 77%, p = 0.037), and velocity (164 ± 58% vs. 117 ± 45%, p = 0.011). Conclusion: Axillary plexus block produces an improvement of peripheral tissue oxygen saturation of the upper extremities over the first 6 h after the inception of anesthesia. This suggests a potential benefit especially for critically perfused tissues.

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Peripheral Nerve Blockade with Combined Standard and Liposomal Bupivacaine in Major Lower‐Extremity Amputation

et al. 2020

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Background and Objectives: Optimizing perioperative analgesia for patients undergoing major lower-extremity amputation remains a considerable challenge. The utility of liposomal bupivacaine as a component of peripheral nerve blockade for lower-extremity amputation is unknown. Methods: We conducted an observational study comparing three different perioperative analgesic techniques for adults undergoing major lower-extremity amputation under general anesthesia between 2012 and 2017 at an academic medical center: (1) no regional anesthesia, (2) peripheral

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Quantification of the vasodilatory effect of axillary plexus block. A prospective controlled study

Cited by 4 publications

References 14 publications

Improvement of Superficial and Deep Cutaneous Microcirculation Due to Axillary Plexus Anesthesia Impaired by Smoking

Improvement of Superficial and Deep Cutaneous Microcirculation Due to Axillary Plexus Anesthesia Impaired by Smoking

Skin Perfusion Changes within 12 h after Axillary Plexus Block

Peripheral Nerve Blockade with Combined Standard and Liposomal Bupivacaine in Major Lower‐Extremity Amputation

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