Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China -
Minerva Anestesiol. 2023 Jul-Aug;89(7-8):671-679. doi: 10.23736/S0375-9393.23.17065-9. Epub 2023 Feb 17.
Regional anesthesia (RA) is a common and irreplaceable technique in clinical, which can be used in different surgery sites and control of acute and chronic pain, especially for outpatients, pediatrics and the elderly. RA demands are increasing during COVID-19 pandemic because many surgeries could be performed under RA to reduce the risk of cross-infection between patients and health care workers. Early and accurate identification of the effects of RA can help physicians make timely decisions about whether to supplement analgesics or switch to general anesthesia, which will save time and improve patient satisfaction in a busy operating room. Perfusion index (PI) is a parameter derived from photoplethysmography (PPG) and represents the ratio of pulsatile and non-pulsatile blood flow at monitoring sites. It reflects local perfusion and is mainly affected by stroke volume and vascular tone. With characteristics of non-invasive, rapid, simple, and objective, PI is widely used in clinical practice, such as fluid responsiveness prediction, nociceptive assessment, etc. Recently, many studies have assessed the accuracy of PI in early prediction of RA success, including brachial plexus block, sciatic nerve block, neuraxial anesthesia, paravertebral block, caudal block and stellate ganglion block. Successful RA often parallels increased PI. In this narrative review, we describe the principles and influencing factors of PI, and introduce the effects of PI on early identification of RA effectiveness.
区域麻醉（RA）是临床中一种常见且不可或缺的技术，可用于不同的手术部位，并可控制急性和慢性疼痛，尤其适用于门诊患者、儿科患者和老年患者。在 COVID-19 大流行期间，对 RA 的需求不断增加，因为许多手术可以在 RA 下进行，以降低患者和医护人员之间交叉感染的风险。早期、准确地识别 RA 的效果可以帮助医生及时决定是否补充镇痛药或改用全身麻醉，这将在繁忙的手术室中节省时间并提高患者满意度。灌注指数（PI）是一种从光体积描记法（PPG）中得出的参数，代表监测部位搏动性和非搏动性血流的比值。它反映了局部灌注情况，主要受每搏输出量和血管张力的影响。PI 具有非侵入性、快速、简单、客观等特点，已广泛应用于临床实践中，如液体反应性预测、伤害性评估等。最近，许多研究评估了 PI 在 RA 成功早期预测中的准确性，包括臂丛神经阻滞、坐骨神经阻滞、椎管内麻醉、椎旁阻滞、骶管阻滞和星状神经节阻滞。成功的 RA 通常与 PI 的增加平行。在本综述中，我们描述了 PI 的原理和影响因素，并介绍了 PI 对早期识别 RA 效果的影响。
