宫颈动脉多普勒指数：颞上阻塞后宫颈段保存的新预测指标：一项前瞻性观察研究

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion Pub Date : 2025-07-21 DOI:10.1016/j.redar.2025.501899

M. Adolf Helmy, M. Medhat Megalaa, H. Mohamed Mamdouh, I.A. Ismail, L. Magdy Milad

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引用次数: 0

摘要

背景锁骨上臂丛阻滞与全身麻醉相比有许多优点，但节段性尺骨保留是该手术的主要缺点之一。提出了许多参数来确定节段性尺骨保留，包括热成像和灌注指数。然而，没有一个被证明是最佳的；因此，我们旨在评估尺动脉多普勒指数作为节段性尺动脉保留的潜在预测指标。方法本前瞻性观察研究在某三级医学中心进行。为了获得90%的研究效能和0.05的α误差，至少需要62例患者的样本量，其中至少有11例患者表现出节段性尺骨保留。在手外科手术中接受锁骨上臂丛阻滞的成年患者也包括在内。根据运动和感觉功能评估每个皮节。一位经验丰富的操作员在阻滞给药后的基线、10分钟、20分钟和30分钟进行多普勒检查。主要结果是PI变化预测尺节段性保留的准确性（ΔPI）。其他结果包括电阻指数的变化（ΔRI）和波形形态的变化（ΔM），以预测节段性尺节段性保留。结果在81例评估合格的患者中，15例被排除，剩下66例最终分析。66例患者中有11例尺节段性保留。ΔPI和ΔRI已被确定为节段性尺骨保留的准确预测因子，最佳临界值分别为8.8%和12%。此外，尺动脉多普勒形态学变化从三相模式到单相波可以排除节段性尺动脉保留，100%阴性预测值。结论在锁骨上臂丛神经阻滞行手外科手术的成年患者中，多普勒指数ΔPI、ΔRI和ΔM的变化对预测尺骨节段保留有较好的准确性。然而，我们的研究结果的普遍性受到单中心研究和相对较小的样本量的限制。

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Índices Doppler de la arteria cubital, un nuevo predictor emergente de la preservación segmentaria del cúbito después del bloqueo supraclavicular: un estudio observacional prospectivo

Background

Supraclavicular brachial plexus block offers several advantages over general anesthesia, yet segmental ulnar sparing is one of the procedure's key drawbacks. Many parameters were proposed to ascertain segmental ulnar sparing, including thermal imaging and perfusion index. However, none proved optimal; therefore, we aimed to evaluate ulnar artery Doppler indices as a potential predictor of segmental ulnar sparing.

Methods

This prospective observational study was conducted at a tertiary center. To obtain a study power of 90% and an alpha error of 0.05, a minimum sample size of 62 patients was required, with a minimum of 11 patients exhibiting segmental ulnar sparing. Adult patients who received supraclavicular brachial plexus block for hand surgery were included. Each dermatome was assessed in terms of motor and sensory function. An experienced operator performed Doppler examinations at baseline, 10-, 20-, and 30 minutes following block administration. The primary outcome was the accuracy of the change in PI (ΔPI) in predicting segmental ulnar sparing. Other outcomes included the change in resistive index (ΔRI) and the change in waveform morphology (ΔM) to predict segmental ulnar sparing

Results

Of the 81 patients assessed for eligibility, 15 were excluded, leaving sixty-six in the final analysis. Eleven of the 66 individuals showed segmental ulnar sparing. ΔPI and ΔRI have been identified as accurate predictors of segmental ulnar sparing with best cut-off values of < 8.8% and 12%, respectively. Additionally, ulnar artery Doppler morphological changes from triphasic pattern to a monophasic wave can rule out segmental ulnar sparing with a 100% negative predictive value.

Conclusion

In adult patients undergoing hand surgery using supraclavicular brachial plexus block, Changes of Doppler indices, namely ΔPI, ΔRI, and ΔM, showed good accuracy in predicting segmental ulna preservation. However, the generalizability of our findings is limited by being a single-center study with a relatively small sample size.

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