Clinical Autonomic Research

, Volume 29, Issue 2, pp 257–259 | Cite as

Perfusion index as a tool to evaluate the efficacy of stellate ganglion block for complex regional pain syndrome

  • Eung Don Kim
  • Woo Joo Yoo
  • Yun Jae Lee
  • Hue Jung ParkEmail author
Letter to the Editor

Dear Editors,

Vasomotor disturbance symptoms such as abnormal thermal sensation are common in patients with complex regional pain syndrome (CRPS) [1]. Sympathetic blocks can be applied to treat such vasomotor symptoms, and stellate ganglion block (SGB) is commonly used to manage CRPS involving the upper extremities [2]. To date, observations of the temperature increase on the treated side and the Horner’s sign have been used as indicators of successful SGB [3]. However, in clinical practice, patients with chronic CRPS often have ambiguous changes in parameters such as temperature after a sympathetic block.

Perfusion index (PI) is a parameter calculated from photoplethysmography and reflects the perfusion state of the monitoring site. PI is expressed as the ratio (%) of the amplitude of the non-pulsatile signal to the amplitude of the pulsatile signal and its value ranges from 0.02–20% [4]. In previous studies, PI was reported more sensitive than temperature as a parameter to measure...


Sympathetic block Stellate ganglion block Complex regional pain syndrome Temperature Perfusion index 



Complex regional pain syndrome


Stellate ganglion block


Perfusion index




Side differences in perfusion index increase


Side differences in temperature increase



There was no funding of this research.

Compliance with ethical standards

Conflict of interest

The authors confirm that there is no conflict of interest.

Supplementary material

10286_2018_585_MOESM1_ESM.tif (202 kb)
Figure 1. Changes in parameters (temperature and PI) and percentage of changes in parameters after SGB over time. A: Changes in temperature after SGB. B: Changes in PI after SGB. C: Percentage of changes in temperature and PI after SGB over time. SGB: Stellate ganglion block. PI: Perfusion index. * p < 0.05 compared with baseline. # p < 0.001 compared with baseline (TIFF 202 kb)


  1. 1.
    Kortekaas MC, Niehof SP, Stolker RJ, Huygen FJ (2016) Pathophysiological mechanisms involved in vasomotor disturbances in complex regional pain syndrome and implications for therapy: a review. Pain Pract 16:905–914CrossRefGoogle Scholar
  2. 2.
    Day M (2008) Sympathetic blocks: the evidence. Pain Pract 8:98–109CrossRefGoogle Scholar
  3. 3.
    Schürmann M, Gradl G, Wizgal I et al (2001) Clinical and physiologic evaluation of stellate ganglion blockade for complex regional pain syndrome type I. Clin J Pain 17:94–100CrossRefGoogle Scholar
  4. 4.
    Lima A, Bakker J (2013) Noninvasive monitoring of peripheral perfusion. Intensive Care Med 31:1316–1326CrossRefGoogle Scholar
  5. 5.
    Ginosar Y, Weiniger CF, Meroz Y et al (2009) Pulse oximeter perfusion index as an early indicator of sympathectomy after epidural anesthesia. Acta Anaesthesiol Scand 53:1018–1026CrossRefGoogle Scholar
  6. 6.
    Huang B, Sun K, Zhu Z et al (2013) Oximetry-derived perfusion index as an early indicator of CT-guided thoracic sympathetic blockade in palmar hyperhidrosis. Clin Radiol 68:1227–1232CrossRefGoogle Scholar
  7. 7.
    Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR (2007) Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med 8:326–331CrossRefGoogle Scholar
  8. 8.
    Coderre TJ, Bennett GJ (2010) A hypothesis for the cause of complex regional pain syndrome-type I (reflex sympathetic dystrophy): pain due to deep-tissue microvascular pathology. Pain Med 11:1224–1238CrossRefGoogle Scholar
  9. 9.
    Dayan L, Salman S, Norman D, Vatine JJ, Calif E, Jacob G (2008) Exaggerated vasoconstriction in complex regional pain syndrome-1 is associated with impaired resistance artery endothelial function and local vascular reflexes. J Rheumatol 35:1339–1345Google Scholar
  10. 10.
    Groeneweg JG, Huygen FJ, Heijmans-Antonissen C, Niehof S, Zijlstra FJ (2006) Increased endothelin-1 and diminished nitric oxide levels in blister fluids of patients with intermediate cold type complex regional pain syndrome type 1. BMC Musculoskelet Disord 7:91CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain Medicine, School of Medicine, The Catholic University of KoreaDaejeon St. Mary’s HospitalDaejeonRepublic of Korea
  2. 2.Department of Anesthesiology and Pain Medicine, School of Medicine, The Catholic University of KoreaSeoul St. Mary’s HospitalSeoulRepublic of Korea

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