Abstract
Background: Understanding microvascular physiology is key to any reconstructive procedure. Current concepts in anesthesia increasingly involve regional peripheral nerve blockade during microvascular reconstructive procedures. Whereas favorable effects on perfusion due to these techniques have been reported earlier, little evidence focusing on its effects in most peripheral vascular compartments is available. Methods: A total of 30 patients who were to receive axillary plexus blockade (APB) were included. Microcirculatory assessment of the dependent extremity was conducted utilizing combined laser-Doppler flowmetry and white light spectroscopy. Two probes (1–2 and 7–8 mm penetration depth) were used to assess changes in microcirculation. Results: APB resulted in significant changes to both superficial and deep cutaneous microcirculation. Changes in blood flow were most prominent in superficial layers with a maximum increase of +617% compared to baseline values. Significantly lower values of +292% were observed in deep measurements. Consecutively, a significant enhancement in tissue oxygen saturation was observed. Further analysis revealed a significant impairment of perfusion characteristics due to reported nicotine consumption (max Bf: +936% vs. +176%). Conclusion: Cutaneous microcirculation is strongly affected by APB, with significant differences regarding microvascular anatomy and vascular physiology. Smoking significantly diminishes the elicited improvements in perfusion. Our findings could influence reconstructive strategies as well as dependent perioperative anesthetic management.
Highlights
This article is an open access articleRegional anesthesia, such as axillary plexus anesthesia, has evolved as a standard procedure in the current practice of perioperative analgesia
Derived from the available literature, it is commonly accepted that regional anesthesia has a beneficial influence on perfusion dynamics as well as on local microcirculation [4,5,6]
In order to represent the complexity of the microvascular network, we focused on the assessment of microcirculation in superficial and deep dermal/subdermal tissue layers with an explorative approach
Summary
This article is an open access article. Regional anesthesia, such as axillary plexus anesthesia, has evolved as a standard procedure in the current practice of perioperative analgesia. Derived from the available literature, it is commonly accepted that regional anesthesia has a beneficial influence on perfusion dynamics as well as on local microcirculation [4,5,6]. Despite earlier publications already acknowledging the benefits of regional anesthesia in the context of microsurgical interventions, such as digital replantation, there is only limited evidence available from clinical trials with an emphasis on its effects on free flap perfusion and microcirculatory characteristics [7,8,9]. Reduced vascular tone due to sympathetic blockade, which otherwise represents one major vasoconstrictive agent, may reduce vasospasm of microvessels and transplanted tissues
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