Blinded Observer Evaluation of Distal Skin Temperature for Predicting Lateral Infraclavicular Block Success

TY - JOUR

T1 - Blinded Observer Evaluation of Distal Skin Temperature for Predicting Lateral Infraclavicular Block Success

AU - Asghar, Semera

AU - Lange, Kai H W

AU - Lundstrøm, Lars H

PY - 2015/1

Y1 - 2015/1

N2 - BACKGROUND: Changes in digit skin temperature may be used to predict and determine upper limb nerve block success. We investigated whether a temperature difference between the blocked and the nonblocked hands, simply registered by touching the skin of the 5th and 2nd digit was valid and reliable as a diagnostic test for predicting a successful lateral infraclavicular block.METHODS: Blinded observers investigated temperature difference between the blocked and the nonblocked hands of 40 patients. Sensitivity, specificity, and predictive values of a positive and a negative test were estimated for evaluating the validity of a temperature difference for predicting a successful lateral infraclavicular block defined by sensory and motor block of all 4 major nerves (musculocutaneous, radial, ulnar, and median nerves). κ statistics of interobserver agreement were used for evaluating the reliability of the test.RESULTS: As a stand-alone test, a temperature difference between the corresponding 2nd and 5th digits of the blocked and the nonblocked hands predicted a successful block with a sensitivity of 92% (95 % confidence interval (CI), 83%-97%) and with a predictive value of a positive test of 95% (CI, 86%-98%). Fleiss κ for multiple observers was 0.74, (CI, 0.61-0.87) for the 5th digit and 0.87 (CI, 0.73-0.998) for the 2nd digit, respectively.CONCLUSIONS: We found that a qualitative difference in skin temperature between the blocked and nonblocked hands, measured distally on the 2nd and 5th digits, was a valid and reliable diagnostic test for predicting successful lateral infraclavicular block.

AB - BACKGROUND: Changes in digit skin temperature may be used to predict and determine upper limb nerve block success. We investigated whether a temperature difference between the blocked and the nonblocked hands, simply registered by touching the skin of the 5th and 2nd digit was valid and reliable as a diagnostic test for predicting a successful lateral infraclavicular block.METHODS: Blinded observers investigated temperature difference between the blocked and the nonblocked hands of 40 patients. Sensitivity, specificity, and predictive values of a positive and a negative test were estimated for evaluating the validity of a temperature difference for predicting a successful lateral infraclavicular block defined by sensory and motor block of all 4 major nerves (musculocutaneous, radial, ulnar, and median nerves). κ statistics of interobserver agreement were used for evaluating the reliability of the test.RESULTS: As a stand-alone test, a temperature difference between the corresponding 2nd and 5th digits of the blocked and the nonblocked hands predicted a successful block with a sensitivity of 92% (95 % confidence interval (CI), 83%-97%) and with a predictive value of a positive test of 95% (CI, 86%-98%). Fleiss κ for multiple observers was 0.74, (CI, 0.61-0.87) for the 5th digit and 0.87 (CI, 0.73-0.998) for the 2nd digit, respectively.CONCLUSIONS: We found that a qualitative difference in skin temperature between the blocked and nonblocked hands, measured distally on the 2nd and 5th digits, was a valid and reliable diagnostic test for predicting successful lateral infraclavicular block.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Brachial Plexus

KW - Female

KW - Fingers

KW - Forearm

KW - Hand

KW - Humans

KW - Male

KW - Middle Aged

KW - Nerve Block

KW - Observer Variation

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Reproducibility of Results

KW - Skin Temperature

KW - Young Adult

U2 - 10.1213/ANE.0000000000000475

DO - 10.1213/ANE.0000000000000475

M3 - Journal article

C2 - 25313969

SN - 0003-2999

VL - 120

SP - 246

EP - 251

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

IS - 1

ER -