Trajectory of temperature changes in upper extremity after an axillary block 
Martin Kiik, MBBS, Sheila Gokul, MD, Patrick Collins, BS, Jenna M. Wilson, PhD, Philipp Lirk, MD, PhD, Kristin Schreiber, MD, PhD, Yun-Yun K. Chen, MD 
Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, USA

Background 

Temperature changes in the upper or lower extremity have been used as markers for successful sympathetic blockade from stellate ganglion and lumbar sympathetic blocks, respectively.1,2

Peripheral nerve blockade, which blocks sympathetic autonomic nerves along with sensory and motor nerves, results in vasodilation and subsequent increase in temperature,3 which may be an important benefit of regional anesthesia in plastic and vascular surgery.4 

Aim

To characterize the trajectory temperature changes after an axillary nerve block and its relationship to motor and sensory onset and resolution

 

Conclusion

 

• After an axillary block, significant skin temperature differences compared to control arm persisted longer than 60 minutes after return of motor function

• Skin temperature may serve as a noninvasive proxy for sympathetic blockade

• Prolonged vasodilation may lead to changes in core temperature and hypothermia in at risk patients

References

 

1. Park SY, Nahm FS, Kim YC, Lee SC, Sim SE, Lee SJ. The cut-off rate of skin temperature change to confirm successful lumbar sympathetic block. J Int Med Res. 2010;38(1):266-275. doi:10.1177/147323001003800131

2. Stevens RA, Stotz A, Kao TC, Powar M, Burgess S, Kleinman B. The relative increase in skin temperature after stellate ganglion block is predictive of a complete sympathectomy of the hand. Reg Anesth Pain Med. 1998;23(3):266-270. doi:10.1016/s1098-7339(98)90053-0

3. Minville V, Gendre A, Hirsch J, et al. The Efficacy of Skin Temperature for Block Assessment After Infraclavicular Brachial Plexus Block. Anesth Analg. 2009;108(3):1034. doi:10.1213/ane.0b013e318195bf94

4. Jorgensen MS, Farres H, James BLW, et al. The Role of Regional versus General Anesthesia on Arteriovenous Fistula and Graft Outcomes: A Single-Institution Experience and Literature Review. Ann Vasc Surg. 2020;62:287-294. doi:10.1016/j.avsg.2019.05.016