The importance of perfusion index monitoring in evaluating the efficacy of stellate ganglion blockage treatment in Raynaud’s disease

Abstract

Stellate ganglion blockage (SGB) is a method used for treating Raynaud’s phenomenon (RP). This study primarily aimed to determine whether the perfusion index (PI) can be used an alternative to Horner’s signs in evaluating the efficacy of SGB in patients diagnosed with RP. In a total of 40 patients, aged 18–65 years and diagnosed with primary RP, SGB was applied for 5 days on the same side with the 2-finger method, using 6 mL of 5% levobupivacaine at the 7th cervical vertebra level. The PI values were recorded from the distal end of the 2nd finger of the upper extremity on the side applied with the block at baseline and at 5, 15, 30, 60 and 120 min. The onset time of Horner findings was recorded. The PI values and visual analogue scale (VAS) pain scores were recorded pre-treatment and after 2 weeks.When the PI values of the 40 patients were examined, a 62.7% increase was observed from baseline to the first session at 5 min (p < 0.05). When all sessions were evaluated, a statistically significant increase was determined in the PI values measured at 5, 15, 30, 60 and 120 min compared with the baseline PI values. There was a statistically significant decrease in the post-treatment VAS pain scores and a statistically significant increase in the post-treatment PI values (p < 0.05). By eliminating peripheral vasospasm with the application of SGB in patients with RP, the distal artery blood flow and PI are increased. PI measurement is a more objective method and therefore could be used as an alternative to Horner findings in evaluating the success of SGB. PI is a non-invasive and simple measurement and also an earlier indicator in evaluating the success of SGB than Horner’s signs.

The effect of epinephrine on the perfusion index during ultrasound-guided supraclavicular brachial plexus block: a randomized controlled trial

“…A previous study measured the PI values at relatively wide intervals (10 min), but we used shorter intervals (5 min). Although there were no mentions of the PI ratio, previous studies have compared the baseline PI with the PI value after 5 min and reported its statistical significance 19 – 21 . In addition, it was confirmed that the PI at 5 min after the SCBPB was the fastest reference point for the change in the PI as a result of AUROC analysis, and the AUROCs were not significantly different across time intervals.…”

Correlation of Perfusion Index Change and Analgesic Efficacy in Transforaminal Block for Lumbosacral Radicular Pain

“…Mowafi and colleagues [22] showed that PI is a reliable measure for the intravascular injection of epinephrine during epidural anesthesia. Some reports have described the use of PI in various conditions, namely, for pain assessment in critically ill patients, at the onset of stellate ganglion block, in lumbar and thoracic sympathectomy, or for prediction of the success of brachial plexus or sciatic nerve blocks [21,23,24,25,26].…”

Evaluation of the Intraoperative Perfusion Index for Correlation with Acute Postoperative Pain in Patients Undergoing Laparoscopic Colorectal Cancer Surgery

“…Mowafi and colleagues [18] demonstrated that the PI is a reliable measure for the intravascular injection of epinephrine during epidural anesthesia. Some reports have indicated that the PI can be used for pain assessment in patients with critical illnesses, at the onset of stellate ganglion block, in lumbar and thoracic sympathectomy, or for predicting the success of brachial plexus, sciatic, or lumbar transforaminal blocks [20,23,24,25,26,27].…”