Delayed recovery of nerve conduction and vibratory sensibility after ischaemic block in patients with diabetes mellitus

Abstract

Objectives-To determine if the recovery of nerve function after ischaemic block is impaired in patients with diabetes mellitus relative to healthy controls. Methods-Median nerve impulse conduction and vibratory thresholds in the same innervation territory were studied in patients with diabetes mellitus (n = 16) and age matched controls (n = 10) during and after 30 minutes of cuYng of the forearm. Results-CuYng caused a 50% reduction of the compound nerve action potential (CNAP) after 21.9 (SEM 1.6) minutes in patients with diabetes mellitus and after 10.6 (0.7) minutes in controls. After release of the cuV the half life for CNAP recovery was 5.13 (0.45) minutes in patients with diabetes mellitus and <1 minute in controls. At seven minutes after release of the cuV CNAP was fully restored in the controls whereas in patients with diabetes mellitus CNAP had only reached 75.1 (4.1)% of its original amplitude. After onset of ischaemia it took 14.6 (1.9) minutes in patients with diabetes mellitus before the vibratory threshold was doubled, whereas this took 5.8 (0.8) minutes in controls. After release of the cuV half time for recovery of vibratory threshold was 8.8 (1.0) minutes in patients with diabetes mellitus and 2.6 (0.3) minutes in controls. Ten minutes after the cuff was released the threshold was still raised (2.0 (0.3)-fold) in the diabetes mellitus group, whereas it was normalised in controls. Among patients with diabetes mellitus the impaired recovery correlated with older age, higher HbA1c, and signs of neuropathy, but not with blood glucose. Conclusion-After ischaemia there is a delayed recovery of nerve conduction and the vibratory sensibility in patients with diabetes mellitus. Impaired recovery after ischaemic insults may contribute to the high frequency of entrapment neuropathy in patients with diabetes mellitus.

Prolonged ischemic conduction failure after reperfusion in diabetic nerve

“…The present study demonstrated that, in diabetic nerve, there was delayed recovery or persistent failure of impulse transmission upon reperfusion following 60–120 min of ischemia, in contrast to immediate recovery in control nerve. The presence of delayed recovery of compound nerve action potentials in the median nerve and of vibratory sensation in diabetic patients has been described after 30 min of ischemia induced by cuff compression in the forearm 6. We observed an immediate recovery of ischemic conduction failure with reperfusion after 30 min of ischemia in both diabetic and nondiabetic nerves.…”

Relationship Between Glycosylated Hemoglobin Level and Sciatic Nerve Block Performance in Diabetic Patients

“…Kroin and colleagues 10 demonstrated that the duration of sciatic nerve block with local anesthetics is longer in diabetic rats versus nondiabetic rats. In addition, delayed recovery of nerve conduction and vibratory sensibility after ischemic block in patients with DM compared with age-matched controls was shown by Lindström et al 12 Our finding of prolonged sensory regression time in patients with poor glycemic control (group 3) compared with patients with better glycemic control (group 1 and group 2) is consistent with existing findings obtained from animal and human studies. We also found that block performance and block onset times were longer in patients with poor glycemic control (group 3).…”

“…Although performing peripheral nerve block in diabetic patients who have peripheral neuropathy is controversial, 6 the impact of DM on the practice of peripheral nerve blocks has not been fully evaluated. Lindström et al 12 showed delayed recovery of nerve conduction and vibratory sensibility after ischemic block in patients with DM compared with age-matched controls.…”

Quantitative sensory tests (perceptual thresholds) in patients with spinal cord injury

“…All three stimulation types had been used previously for assessing sensory function, mainly in peripheral neuropathies [2][3][4][5][6], radiculopathies [7][8], and brachial plexus lesions [9]. Some QSTs have been used in patients with incomplete SCI [10][11][12].…”