Comparison of peripheral nerve blockade characteristics between non-diabetic patients and patients suffering from diabetic neuropathy: a prospective cohort study.

TitreComparison of peripheral nerve blockade characteristics between non-diabetic patients and patients suffering from diabetic neuropathy: a prospective cohort study.
Publication TypeJournal Article
Year of Publication2018
AuthorsBaeriswyl, M, Taffé, P, Kirkham, KR, Bathory, I, Rancati, V, Crevoisier, X, Cherix, S, Albrecht, E
JournalAnaesthesia
Volume73
Issue9
Pagination1110-1117
Date Published09/2018
DOI10.1111/anae.14347
ISSN1365-2044
Mots-clés80 and over, Adult, Aged, Analgesia, Analgesics, Anesthetics, Case-Control Studies, Diabetes Mellitus, Diabetic Foot/etiology, Diabetic Foot/physiopathology, Diabetic Foot/surgery, Drug Administration Schedule, Female, Foot/surgery, Humans, Interventional, Local/administration & dosage, Local/pharmacology, Male, Middle Aged, Nerve Block/methods, Opioid/administration & dosage, Pain, Pain Measurement/methods, peripheral nerve block, Postoperative/prevention & control, Prospective Studies, Sciatic Nerve/diagnostic imaging, Sciatic Nerve/drug effects, Sciatic Nerve/physiopathology, Sensation/drug effects, Time Factors, Type 2/complications, Type 2/physiopathology, Ultrasonography, Young Adult
Abstract

Animal data have demonstrated increased block duration after local anaesthetic injections in diabetic rat models. Whether the same is true in humans is currently undefined. We, therefore, undertook this prospective cohort study to test the hypothesis that type-2 diabetic patients suffering from diabetic peripheral neuropathy would have increased block duration after ultrasound-guided popliteal sciatic nerve block when compared with patients without neuropathy. Thirty-three type-2 diabetic patients with neuropathy and 23 non-diabetic control patients, scheduled for fore-foot surgery, were included prospectively. All patients received an ultrasound-guided popliteal sciatic nerve block with a 30 ml 1:1 mixture of lidocaine 1% and bupivacaine 0.5%. The primary outcome was time to first opioid request after block procedure. Secondary outcomes included the time to onset of sensory blockade, and pain score at rest on postoperative day 1 (numeric rating scale 0-10). These outcomes were analysed using an accelerated failure time regression model. Patients in the diabetic peripheral neuropathy group had significantly prolonged median (IQR [range]) time to first opioid request (diabetic peripheral neuropathy group 1440 (IQR 1140-1440 [180-1440]) min vs. control group 710 (IQR 420-1200 [150-1440] min, p = 0.0004). Diabetic peripheral neuropathy patients had a time ratio of 1.57 (95%CI 1.10-2.23, p < 0.01), experienced a 59% shorter time to onset of sensory blockade (median time ratio 0.41 (95%CI 0.28-0.59), p < 0.0001) and had lower median (IQR [range]) pain scores at rest on postoperative day 1 (diabetic peripheral neuropathy group 0 (IQR 0-1 [0-5]) vs. control group 3 (IQR 0-5 [0-9]), p = 0.001). In conclusion, after an ultrasound-guided popliteal sciatic nerve block, patients with diabetic peripheral neuropathy demonstrated reduced time to onset of sensory blockade, with increased time to first opioid request when compared with patients without neuropathy.

Alternate URL

http://www.ncbi.nlm.nih.gov/pubmed/29858510?dopt=Abstract

First publication date (online)

06/2018

WOS ID (UT)

000442206900009

Alternate JournalAnaesthesia
Citation Key / SERVAL ID8939
Peer reviewRefereed
PubMed ID29858510

                         

IUMSP | www.iumsp.ch
Institut universitaire de médecine sociale et préventive
Route de la Corniche 10, 1010 Lausanne - Switzerland
+41 21 314 72 72 | iumsp@chuv.ch

Go to top