Asghar S, Lundstrøm L H, Bjerregaard L S, Lange K H W
Department of Anaesthesia and Intensive Care, Nordsjaellands Hospital, Hillerød, Denmark; Copenhagen University Hospital, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2014 Aug;58(7):867-74. doi: 10.1111/aas.12351. Epub 2014 Jun 12.
Brachial plexus blocks cause changes in hand and digit skin temperature. We investigated thermographic patterns after the lateral infraclavicular brachial plexus block. We hypothesised that a successful lateral infraclavicular block could be predicted by increased skin temperature of the 2nd and 5th digits.
We performed an ultrasound-guided lateral infraclavicular block in 45 patients undergoing upper limb surgery. The contralateral hand served as control and we obtained infrared thermographic images of both hands before the block and during the following 30 min. We defined areas of interest on the hands and analysed mean skin temperature of each area.
Forty patients completed the study. Thirty blocks were successful, six were failures and four were partial failures. Four distinct patterns of skin temperature changes were revealed with highly significant changes in temperature, depending on block success. A simultaneous 1 °C ipsilateral increase in skin temperature of the 2nd and 5th digits predicted a successful block with a positive predictive value of 100%. A 5 °C difference in digit skin temperature compared with the contralateral hand had a positive predictive value of 96%, and a digit skin temperature ≤ 30 °C 30 min after performing the block had a predictive value of 100% for a failed block.
Four different thermographic patterns were found. Simultaneous increases in skin temperature of both the 2nd and 5th digits predicted lateral infraclavicular block success with a positive predictive value of 100%. Digit skin temperature ≤ 30 °C 30 min after performing the block indicated block failure.
臂丛神经阻滞会导致手部和手指皮肤温度发生变化。我们研究了锁骨下臂丛神经外侧阻滞术后的热成像模式。我们假设，通过第二和第五手指皮肤温度升高可以预测锁骨下臂丛神经外侧阻滞成功。
我们对45例接受上肢手术的患者实施了超声引导下锁骨下臂丛神经外侧阻滞。对侧手作为对照，在阻滞前及随后30分钟内获取双手的红外热成像图像。我们在手上定义了感兴趣区域，并分析每个区域的平均皮肤温度。
40例患者完成了研究。30例阻滞成功，6例失败，4例部分失败。根据阻滞成功情况，揭示了四种不同的皮肤温度变化模式，温度变化具有高度显著性。第二和第五手指皮肤温度同时同侧升高1°C预测阻滞成功，阳性预测值为100%。手指皮肤温度与对侧手相比相差5°C，阳性预测值为96%，阻滞30分钟后手指皮肤温度≤30°C对阻滞失败的预测值为100%。
发现了四种不同的热成像模式。第二和第五手指皮肤温度同时升高预测锁骨下臂丛神经外侧阻滞成功，阳性预测值为100%。阻滞30分钟后手指皮肤温度≤30°C表明阻滞失败。
