Photoplethysmographic signals to predict the success of lumbar sympathetic blockade for lower extremity pain.

Abstract

A prospective, observational study to investigate how photoplethysmography (PPG) signals change during lumbar sympathetic blockade (LSB), and whether these changes can predict sympathetically mediated pain (SMP). Patients with unilateral lower extremity pain and self-reported cold hyperalgesia underwent LSB. Bilateral temperature and PPG signals (AC and DC) were recorded. Power spectrum analysis (PSA) was performed. Of the total patient cohort (n = 38), eight patients (22.1%) had excellent pain-relief after LSB and were determined to have SMP. In all patients, the PPG AC signal changed immediately after drug administration, before any temperature change. DC signals decreased slowly in a linear fashion. PSA of DC signals showed significantly lower low-frequency/high-frequency (LF/HF) ratios in the SMP group than the sympathetically independent pain group, both before and after LSB. A cut-off value of 2.92 for LF/HF resulted in sensitivity, specificity and positive predictive values for SMP of 75.0%, 76.7% and 3.21 [1.5, 6.9], respectively. PPG may be used as an early indicator of a successful LSB and could also be helpful in diagnosing SMP.