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

Sertöz, Nezih; Deni̇z, Mustafa Nuri; Ayanoğlu, Hilmi Ömer

doi:10.1177/1071100712460366

Cited by 21 publications

(13 citation statements)

References 21 publications

(23 reference statements)

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“…17,25,26,30 There is limited clinical data suggesting that the success of peripheral nerve blockade (supraclavicular brachial plexus) may be higher in diabetic patients independent of other predictors of success (eg, body mass index) compared with nondiabetic patients. 31,32 Gebhard and colleagues 30 propose several theories for this finding, including (1) a higher sensitivity of diabetic nerve fibers to local anesthetics, (2) possible unknown intraneural penetration before injection, and (3) preexisting DPN with accompanying decreased sensation. Preexisting pathology has long been reported to play a role in the development of postoperative neurologic dysfunction.…”

Section: Diabetic Polyneuropathymentioning

confidence: 99%

Regional Anesthesia in Patients With Preexisting Neurologic Disease

Kopp

Jacob

Hebl

2015

Regional Anesthesia and Pain Medicine

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Since publication of initial recommendations in 2008, there is limited new information regarding the performance of regional anesthesia in patients with preexisting neurologic diseases. However, the strength of evidence has increased since 2008 regarding (1) the concern that diabetic nerves are more sensitive to local anesthetics and perhaps more susceptible to injury and (2) the concern that performing neuraxial anesthesia and analgesia in patients with preexisting spinal canal pathology may increase the risk of new or worsening neurologic symptoms. This increased evidence reinforces our initial recommendations. In addition, since the initial recommendations in 2008, the concept of postsurgical inflammatory neuropathy has been described and is potentially a contributor to postoperative neurologic dysfunction.

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Section: Diabetic Polyneuropathymentioning

confidence: 99%

Regional Anesthesia in Patients With Preexisting Neurologic Disease

Kopp

Jacob

Hebl

2015

Regional Anesthesia and Pain Medicine

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“…Clinical confirmation of these results in humans was published recently, but the authors studied specifically type‐2 diabetic patients without neuropathy . Other authors have shown that diabetic patients with poor glycaemic control developed a longer block duration when compared with diabetic patients with better glycaemic control . It is noteworthy, however, that none of these three trials performed proper testing for neuropathy .…”

Section: Introductionmentioning

confidence: 93%

“…Other authors have shown that diabetic patients with poor glycaemic control developed a longer block duration when compared with diabetic patients with better glycaemic control . It is noteworthy, however, that none of these three trials performed proper testing for neuropathy . Although the characteristics of ultrasound‐guided regional blocks for both upper and lower limbs have been extensively investigated in patients without neuropathy, the time to onset and block duration in patients suffering from diabetic peripheral neuropathy (DPN) remains unknown.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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“…Consistent with this hypothesis, supplementation with individual agents including AICAR, 26 ATP, 41 and Akt inhibitors including rapamycin and LY294002 25 modify toxicity with bupivacaine in a synergistic or antagonistic fashion. Furthermore, metabolic conditions including diabetes 42,43 and/or deficiency of specific enzymes or cofactors including carnitine 44,45 increase susceptibility to local anesthetic toxicity. Controlling for these effects adds a layer of complexity to the necessary scientific studies, requiring controls for both local anesthetic and for lipid emulsion.…”

Section: Local Anesthestic Systemic Toxicitymentioning

confidence: 99%

The Mechanisms Underlying Lipid Resuscitation Therapy

Fettiplace

Weinberg

2018

Regional Anesthesia and Pain Medicine

101

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The experimental use of lipid emulsion for local anesthetic toxicity was originally identified in 1998. It was then translated to clinical practice in 2006 and expanded to drugs other than local anesthetics in 2008. Our understanding of lipid resuscitation therapy has progressed considerably since the previous update from the American Society of Regional Anesthesia and Pain Medicine, and the scientific evidence has coalesced around specific discrete mechanisms. Intravenous lipid emulsion therapy provides a multimodal resuscitation benefit that includes both scavenging (eg, the lipid shuttle) and nonscavenging components. The intravascular lipid compartment scavenges drug from organs susceptible to toxicity and accelerates redistribution to organs where drug (eg, bupivacaine) is stored, detoxified, and later excreted. In addition, lipid exerts nonscavenging effects that include postconditioning (via activation of prosurvival kinases) along with cardiotonic and vasoconstrictive benefits. These effects protect tissue from ischemic damage and increase tissue perfusion during recovery from toxicity. Other mechanisms have diminished in favor based on lack of evidence; these include direct effects on channel currents (eg, calcium) and mass-effect overpowering a block in mitochondrial metabolism. In this narrative review, we discuss these proposed mechanisms and address questions left to answer in the field. Further work is needed, but the field has made considerable strides towards understanding the mechanisms.

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

Abstract: Level II, prospective comparative study.

Cited by 21 publications

References 21 publications

Regional Anesthesia in Patients With Preexisting Neurologic Disease

Regional Anesthesia in Patients With Preexisting Neurologic Disease

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

The Mechanisms Underlying Lipid Resuscitation Therapy

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