The Application Of Infraorbital Lateral Ultrasonic Pupillary Measurement Method In Stellate Ganglion Block

Part Ⅰ:The method of pupil diameter measurement by infraorbital lateral ultrasoundObjective:Optimize the method of ultrasonic pupil measurement to provide a new position and angle for ultrasonic pupil measurement;To provide the feasibility of operation for pupil examination of patients with orbital injury,and reduce the pain of patients in examination;It provides convenience for emergency and bedside pupil examination,and expands the scope of clinical application of ultrasonic pupil measurement method.Methods:There were 78 healthy volunteers(156 eyes),38 males and 40 females,with an average age of 41 years(20-68 years).The ultrasonic linear array probe was placed at the three sites below the orbit,below the orbit and above the orbit,and the pupil diameter(PD)of both sides was measured quantitatively under the same and stable light intensity.Record the time of measuring the complete pupil image.At the end of each measurement,subjects were scored for comfort.Results:There was no statistical difference between the left and right pupil diameters measured by ultrasound probe placed at the same location(P>0.05).There was no statistical difference in pupil diameter data measured by ultrasound probe placed in three different parts of the lower side of the orbit,the lower part of the orbit and the upper part of the orbit(P>0.05).There was no statistical difference in the time of measuring the complete pupil image between the three methods(P>0.05).The comfort score of the infraorbital lateral ultrasound measurement of pupil was lower than that of the infraorbital and supraorbital ultrasound measurement(P<0.05).Conclusion:The three methods of ultrasonic measurement of pupil can objectively reflect the pupil diameter.The method of infraorbital lateral ultrasonic measurement of pupil is more comfortable and can be used in clinic.Part Ⅱ:Study on pupil changes at different time points before and after stellate ganglion blockObjective:The method of measuring pupil by infraorbital lateral ultrasound is used to measure pupil changes in stellate ganglion block,which can effectively provide objective and quantitative pupil data for stellate ganglion block,increase the feasibility of the use of stellate ganglion block treatment in patients after anesthesia and severe loss of consciousness,and broaden the scope of clinical application of infraorbital lateral ultrasound measuring pupil method.Methods:Thirty-six healthy volunteers,including 15 males and 21 females,aged from 35 to 69 years,were randomly divided into three groups:observation group(group S),control group(group C)and blank group(group B),with 12 cases in each group.All tests were conducted from 8 a.m.to 11 a.m.In group S,SGB(1%lidocaine 4ml)was performed under ultrasound;In group C,local anesthetics were replaced with equal volume of normal saline and SGB;In group B,only the ultrasound probe was placed at the puncture site,and no puncture operation was performed.The occurrence of Horner syndrome(HS)is defined as successful block.Observation time points:30min before block(TT0),1min before block(T0),3min after block(T3),5min(T5),10min(T10),15min(T15),30min after block(TT1).Main outcome measures:pupillary diameter(PD)at T0-T15 time point,contraction rate(CON)before and after pupillary block at both sides,difference of pupillary diameter(IED)at both sides at each time point,and pupillary reflex contraction rate(PLR-CON)under ultrasound at T0 and T15.Secondary outcome measures:heart rate(HR),mean arterial pressure(MAP),lobe pulse oxygen saturation(SPO2),lobe perfusion index(PI),forehead temperature(T),abdominal plasma epinephrine(E)and norepinephrine(NE)in TTO and TT1 at each time point.Results:All people in Group S developed HS after SGB.From T3 to T15,the PD of block side in group S was lower than that in group T0(P<0.05),and also lower than that in group B and group C(P<0.05).At T3～T15,PD of non-blocking side in group S was lower than that in group T0(P<0.05),and that in group T5 and T15 was lower than that in group C.In group S,PD on both sides decreased after SGB(P<0.05),and PD on the blocked side was smaller than that on the opposite side(P<0.05).The CON of the block side was 17.83%～30.58%3～15 min after block,and increased with time;The contralateral CON is 4.50%～6.33%,which does not change with time;The average IED was 0.65 mm～1.27 mm,which increased with time.CON and IED at the block side reached the maximum value of this test within 15 minutes.PLR-CON at T0 and T15 had no statistical difference between the three groups and within the group(P>0.05).The HR of group S at T3 and T5 was lower than that at T0(P<0.05).There was no difference in HR between T0 and T15 groups(P>0.05).T in group S was higher at T15 than at T0(P<0.05),and higher than that in group C and group B at the same time(P<0.05).PI in group S was higher at T3～T15 than at T0(P<0.05),and higher than that in group C and group B at the same time(P<0.05).At TT0,there was no statistically significant difference between the three groups of NE and E(P>0.05);At TT1,NE in group S was lower than that in group C(P<0.05).The comparison within the NE and E groups showed that there was no statistically significant difference in TT0 and TT1 between the S group(P>0.05);The plasma NE and E levels in group C increased at TT1 compared to TT0(P<0.05).There was no statistical difference in the general data of each group(P>0.05).Conclusion:The pupil in SGB was observed by the method of infraorbital lateral ultrasonic measurement of pupil.3 to 15 minutes after SGB,the pupillary contraction of the blocked side was 17.83%to 30.58%,and the difference of pupil diameter between the two sides was 0.65 mm to 1.27 mm,which increased with time,reaching the maximum value of this study at 15 minutes,which can be used as reference data for clinical and scientific research.Part Ⅲ:A clinical study of pupil changes to evaluate the effectiveness of stellate ganglion blockObjective:To quantitatively measure the pupil diameter by infraorbital lateral ultrasound,calculate the change rate of pupil diameter before and after SGB and the difference of pupil diameter on both sides,and provide objective basis for judging stellate ganglion block.Methods:60 patients who needed SGB were included in the pain department of the Second Affiliated Hospital of Suzhou University,and HS after block was determined as effective block.Observation time points:1 min(T0)before block,3 min(T3),5 min(T5),10 min(T10),15 min(T15)after block.Main outcome measures:Pupil diameter(PD)at T0-T15;At T0 and T15,the pupillary light reflex contraction rate(PLR-CON)under ultrasound;Contraction rate(CON)before and after bilateral pupillary block;The difference of pupil diameter(IED)on both sides at each time point.Results:Among 60 cases of SGB,8 cases did not appear HS.There was no statistical difference between the two PD groups and within the group in 8 patients with block failure(P>0.05).The statistical results of 52 patients with HS showed that PD on both sides decreased after SGB(P<0.05),and PD on the blocked side was smaller than that on the opposite side(P<0.05).The AUC of IED to judge the effectiveness of SGB at each time point is greater than 0.9,and the AUC of CON on the blocked side to judge the effectiveness of SGB is greater than 0.8.The maximum area under the curve of IED and effective SGB at 15 min after block is 0.97.At this time,the sensitivity of IED to judge the effectiveness of SGB block is 86.5%,and the specificity is 100%.There was no statistically significant difference in the area under the ROC curve for determining the effectiveness of SGB using non blocking CON(P>0.05).There was no statistically significant difference between the pupil and the light reflex contraction rate before and after block(P>0.05).Conclusion:15 min after stellate ganglion block with 4ml 1%lidocaine,ultrasonic measurement of bilateral pupil diameter difference>0.5 mm can be used as an objective basis to evaluate the effectiveness of stellate ganglion block.