Assessment of palm and axillary temperature changes in determining the success of thoracic paravertebral block in breast cancer patients / 临床麻醉学杂志

ABSTRACT

Objective To observe the skin temperature changes on blocked area of ultrasoundguided thoracic paravertebral block and to explore the accuracy of the temperature changes in predic ting the effect of nerve block in breast cancer patients.Methods One hundred and twenty breast cancer patients undergoing modified radical mastectomy,aged 29-67 years,ASA physical status Ⅰ-Ⅲ,were selected for the study.Before general anesthesia induction,ultrasound-guided thoracic paravertebral block was performed.After the block site T34 was determined,25 ml 0.25％ ropivacaine was injected around the thoracic paravertebral space.The skins of palm and axillary regions both in blocked and unblocked sites were randomly selected.The skin temperature before nerve block and 15 min after were recorded,and the skin temperature changes were calculated.The sensitivity and specificity of the temperature changes in determining the effect of thoracic paravertebral block was assessed by using the receiver operating characteristic curve (ROC).Pearson correlation was used to analyze the correlation.Results The value of area under curve (AUC) of the ROC of the skin temperature changes in palm regions responding to the effects of block was 0.892 (95％CI 0.803-0.947).The cut-off value was 0.9C which sensitivity and specificity was 87.3％ and 75.9％,respectively.The AUC in axillary regions was 0.813 (95％CI 0.756 0.884),the cut-off value was 0.4 C which sensitivity and specificity was 80.7％ and 71.6％,respectively.The value of AUC in palm regions was larger than in axillary regions (P＜0.05).Conclusion The present study demonstrated that the changes of the skin temperature in palm and axillary regions have a high accuracy in predicting the effect of T3-4 thoracic paravertebral block,which can be used in determining the success of T3-4 thoracic paravertebral block.The assessment of temperature changes in palm regions is more accuracy than in axillary.