Use of Pulse Oximeter Perfusion Index to Predict the Success of Supraclavicular Brachial Plexus Block in Various Upperlimb Surgeries
Authors
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Abstract
Background and Aim: Supraclavicular brachial plexus block (SCB) is a widely practiced technique for upper limb surgeries. Traditional assessment of block success is subjective and time-consuming. This study explores the role of perfusion index (PI) and perfusion index ratio (PIR) as objective indicators for early prediction of block success. Material and Methods: A prospective observational study was conducted in 100 ASA I/II patients undergoing elective or emergency upper limb surgeries under SCB. PI and PIR were recorded at baseline and every 5 minutes up to 30 minutes using pulse oximetry. Block success was determined by complete sensory and motor blockade in all four nerve territories. Results: Successful blocks showed a significant increase in PI and PIR from baseline, with PI values at 10 minutes (5.88 ± 1.54) and 30 minutes (8.24 ± 1.84) being markedly higher than those in failed blocks. PIR thresholds greater than 2.0 after 15 minutes were strongly associated with successful blocks (p<0.001). Conclusion: PI and PIR are reliable, early, and non-invasive indicators of SCB success, with potential to enhance perioperative decision-making and reduce reliance on subjective assessments.
##plugins.themes.bootstrap3.article.details##
Copyright (c) 2025 Dr Sayeeda Abdeabiturab Aurangabadwala, Dr Fatema Kutbuddin Mujpurwala, Dr Priyanka S Kandikatla, Dr Divyang V Shah
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
Dr Sayeeda Abdeabiturab Aurangabadwala, Senior Resident, Department of Anaesthesiology, Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, Gujarat, India.
Senior Resident, Department of Anaesthesiology, Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, Gujarat, India.
Dr Fatema Kutbuddin Mujpurwala, Assistant Professor, Department of Anaesthesiology, MGM Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India.
Assistant Professor, Department of Anaesthesiology, MGM Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India.
Dr Priyanka S Kandikatla, Senior Resident, Department of Anaesthesiology, MGM Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India.
Senior Resident, Department of Anaesthesiology, MGM Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India.
Dr Divyang V Shah, Professor, Department of Anaesthesiology, Kiran Medical College, Surat, Gujarat, India.
Professor, Department of Anaesthesiology, Kiran Medical College, Surat, Gujarat, India.
[1] Franco CD. Supraclavicular brachial plexus block. In: Hadzic A, editor. Hadzic’s Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia. 2nd ed. New York: McGraw-Hill; 2012. p. 221-40.
[2] Draisci G, Valeri S, Suppa E, Fina D, Pinto R, Bossone A, et al. Comparative evaluation of the perfusion index and skin temperature after infraclavicular brachial plexus block. Reg Anesth Pain Med. 2016;41(4):403-9.
[3] Galvin EM, Niehof S, Verbrugge SJ, Maissan IM, Jahn A, Klein J, et al. Perfusion index as a noninvasive tool to assess the onset of regional anesthesia: a prospective observational study. Anesth Analg. 2006;102(5):1546-50.
[4] Toyama S, Kakumoto M, Morioka M, Yamakage M. Perfusion index as a tool for the early detection of impaired tissue perfusion during surgery under general anesthesia. Anesth Analg. 2012;114(6):1278-84.
[5] Abdelnasser A, Aboeldahab H, Abdelhamid B. Predictive value of perfusion index for assessing adequacy of peripheral nerve block: a prospective observational study. Egypt J Anaesth. 2017;33(4):381-6.
[6] Lal D, Chandra A, Banerjee A, Bhagat H, Bansal T. Evaluation of perfusion index as a predictor of successful supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol. 2021;37(4):559-64.
[7] Jethava DD, Vora KS, Patel MG. Prediction of success of supraclavicular brachial plexus block using perfusion index and perfusion index ratio. J Clin Diagn Res. 2024;18(11):UC08-UC11.
[8] Chatterjee S, Das A, Kundu S, RoyBasunia S, Das A. Predictive value of perfusion index for assessing success of supraclavicular brachial plexus block: a prospective observational study. Indian J Pain. 2024;38(1):5-10.
[9] Hu H, Zhou S, Zhang J, Wu L. Role of perfusion index in predicting the success of interscalene brachial plexus block. Front Med (Lausanne). 2025;12:1571171.
[10] Bozdağ E, Bağuş F, Özmen S, Candan S, Şahiner Y. Evaluation of the perfusion index for predicting the success of peripheral nerve block: a prospective observational study. Ain-Shams J Anesthesiol. 2023;15(1):61.
[11] Sato K, Ueda T, Nakagawa H, Tanaka Y. Perfusion index as a predictor of brachial plexus block success: A prospective observational study. J Clin Monit Comput. 2023;37(5):1173-80.
[12] Sharma V, Gupta R, Meena YK, Bansal R. Use of perfusion index ratio as a normalized indicator for predicting supraclavicular block efficacy. J Anaesth Clin Res. 2024;15(2):221-6.
[13] Yoshida T, Kato Y, Nakamura M, Iwasaki T. Utility of perfusion index in pediatric regional anesthesia: a multicentre observational study. Paediatr Anaesth. 2024;34(1):52-9.
[14] Rajan A, Pillai V, Thomas R. Differentiation of complete vs. partial brachial plexus block using perfusion index and perfusion index ratio: A clinical correlation. Indian J Anaesth. 2024;68(3):167-72.
[15] Lee JY, Park KH, Min JH, Kim JH. Comparative analysis of perfusion index, skin temperature, and clinical scoring for assessing supraclavicular block efficacy. J Anesth. 2025;39(2):118-25.