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      Clinical Application of Laser Speckle Flowgraphy to Assess Changes in Blood Flow to the Foot After a Lumbar Sympathetic Ganglion Block: A Case Report

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          Abstract

          Background

          The lumbar sympathetic ganglion block (LSGB) has been used as a diagnostic and therapeutic procedure for treating pain conditions such as neuropathic and ischemia-related pain, affecting the lower extremities. In general, an increase in skin temperature is useful in confirming the effectiveness of the sympathetic nerve block in clinical settings. However, the assessment of skin temperature in patients with peripheral arterial disease (PAD) occasionally provides false negatives.

          Case Presentation

          A novel technology, laser speckle flowgraphy (LSFG) enables noninvasive quantitative and qualitative blood flow assessments. LSFG is a novel neuro-monitor for quantitative blood flow detection in the optic nerve head during cardiac surgery. Herein, we report on measuring foot blood flow using LSFG before and after LSGB in a PAD patient. This research aimed to determine whether LSFG could detect any improvement in the dynamics of foot blood flow after an LSGB in a situation where changes in skin temperature alone could not determine the procedure’s outcome.

          Conclusion

          LSFG can be used to assess blood flow changes in a foot with PAD, following a LSGB.

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          Most cited references 10

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          The cut-off rate of skin temperature change to confirm successful lumbar sympathetic block.

           S Y Park,  S Lee,  S Sim (2010)
          The purpose of this study was to find the best cut-off value for the rate of change in temperature of the plantar surface of the foot for predicting the success of lumbar sympathetic block (LSB). A total of 185 LSBs were performed on 82 patients via a posterolateral approach under fluoroscopic guidance. Successful LSB was considered to have occurred when changes in the ipsilateral temperature between pre-block and post-block were > or = 2 degrees C. A receiver operating characteristic (ROC) curve for the minimum rate of temperature change was constructed as a predictor of the onset of a successful LSB. The area under the ROC curve was 0.971 at the rate of 0.4 degrees C/min with a sensitivity of 89.5% and a specificity of 91.8%. Achieving a rate of temperature change of 0.4 degrees C/min within approximately 5 min of the injection of local anaesthetic could be used as an indicator of the onset of successful LSB.
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            Laser speckle flowgraphy can also be used to show dynamic changes in the blood flow of the skin of the foot after surgical revascularization

            Objectives Laser speckle flowgraphy is a new method that enables the rapid evaluation of foot blood flow without contact with the skin. We used laser speckle flowgraphy to evaluate foot blood flow in peripheral arterial disease patients before and after surgical revascularization. Materials and methods A prospective single-center study. Thirty-one patients with 33 limbs that underwent surgical revascularization for peripheral arterial disease were included. Pre- and postoperative foot blood flows were measured on the plantar surface via laser speckle flowgraphy and skin perfusion pressure. The laser speckle flowgraphy device was used to visualize the blood flow distribution of the target skin and processed the pulse wave velocity of synchronized heart beats. The mean blood flow, which was expressed as the area of the pulse wave as the beat strength of skin perfusion on laser speckle flowgraphy converted into a numerical value, was assessed as dynamic changes following surgery. Beat strength of skin perfusion was also investigated in non-peripheral arterial disease controls (23 patients/46 limbs). Results The suitability of beat strength of skin perfusion in non-peripheral arterial disease controls was achieved; the beat strength of skin perfusion value was significantly higher in every area of interest in non-peripheral arterial disease controls compared to that in peripheral arterial disease limbs at the preoperative stage (105.8 ± 8.2 vs. 26.3 ± 8.2; P < 0.01). Although the pulse wave before surgery was visually flat in peripheral arterial disease patients, the pulse wave was remarkably and immediately improved through surgical revascularization. Beat strength of skin perfusion showed a dynamic change in foot blood flow (26.3 ± 8.2 at preoperation, 98.5 ± 6.7 immediately after surgery, 107.6 ± 5.7 at seven days after surgery, P < 0.01 for each compared to preoperation) that correlated with an improvement in skin perfusion pressure. Conclusions Laser speckle flowgraphy is a noninvasive, contact-free modality that is easy to implement, and beat strength of skin perfusion is a useful indicator of foot circulation during the perioperative period. Further analysis with a larger number of cases is necessary to establish appropriate clinical use.
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              Basic Technology and Clinical Applications of the Updated Model of Laser Speckle Flowgraphy to Ocular Diseases

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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                jpr
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                26 May 2021
                2021
                : 14
                : 1451-1456
                Affiliations
                [1 ]Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University , Asahikawa, Hokkaido, 078-8510, Japan
                [2 ]Department of Vascular Surgery, Asahikawa Medical University , Asahikawa, Hokkaido, 078-8510, Japan
                Author notes
                Correspondence: Hirotsugu Kanda Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University , Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, JapanTel +81-166-68-2583Fax +81-166-68-2589 Email h.kanda0629@nifty.com
                Article
                305543
                10.2147/JPR.S305543
                8165217
                © 2021 Kanao-Kanda et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 2, Tables: 3, References: 10, Pages: 6
                Funding
                Funded by: did not receive;
                This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
                Categories
                Case Report

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