Laser Doppler measurements of skin blood flow before,during, and after lumbar sympathetic blockade in children and young adults with reflex sympathetic dystrophy syndrome |
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Authors: | Jose E. Irazuzta MD Charles B. Berde MD PhD Dr Navil F. Sethna MB ChB |
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Affiliation: | (1) From the Department of Anaesthesia, Harvard Medical School, The Children's Hospital, Boston, MA;(2) Pain Treatment Service, Department of Anesthesia, The Children's Hospital, 300 Longwood Ave, 02115 Boston, MA |
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Abstract: | Changes in the skin capillary blood flow (SBF) and temperature before, during, and 1 hour after unilateral lumbar paravertebral sympathetic blockade (LSB) were studied simultaneously with laser Doppler flowmetry and thermometry in patients with reflex sympathetic dystrophy syndrome. The baseline flow measurements in the toes on the affected limb were significantly lower than in the contralateral limb (p<0.01). During LSB, a 10-fold increase in SBF was detected within 4 minutes after injection of a local anesthetic agent when the sympathetic blockade was effective; an increase of more than 1°C in the skin temperature occurred within 11 minutes. Measurements 1 hour after blockade showed an 18-fold (mean) increase in SBF in the toes (p<0.0001) and a 2-fold (mean) increase in SBF in the thighs (p<0.001). There was a significant decrease in the skin blood flow in the contralateral toes after the sympathetic blockade (p<0.01). We conclude that laser Doppler flow measurements can be used to detect immediate onset of sympathetic blockade in patients under general anesthetic or conscious sedation. |
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Keywords: | Measurement techniques: flowmetry Anesthetic techniques: lumbar regional nerve block Complications: reflex sympathetic dystrophy syndrome Monitoring: blood flow temperature |
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