The hemodynamic and pain impact of peripheral nerve block versus spinal anesthesia in diabetic patients undergoing diabetic foot surgery

Lai, Hou Yee; Foo, Li Lian; Lim, Siu Min; Yong, Chen Fei; Loh, Pui San; Chaw, Sook Hui; Hasan, Mohd Shahnaz; Wang, Chew Yin

doi:10.1007/s10286-017-0485-8

Cited by 18 publications

(23 citation statements)

References 23 publications

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“…In recent years, PNB has proven to be effective in various orthopaedic procedures. Intraoperative blood pressure is higher during PNB than that during GA6 or SA,7 8 and PNB provides a more stable haemodynamic state. Owing to a history of severe mitral regurgitation and the potential for hypovolaemia, our patient’s intraoperative haemodynamics were closely monitored.…”

Section: Discussionmentioning

confidence: 84%

Successful peripheral nerve block under dexmedetomidine sedation for femoral neck fracture fixation in a 97-year-old patient

et al. 2021

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Hip fracture is a common injury in elderly patients. In Japan, the number of super-old patients—age >90 years—with hip fractures has increased drastically over time. Available strategies for anaesthetic management for hip fracture surgery include general anaesthesia, neuraxial anaesthesia and peripheral nerve block. However, general and neuraxial anaesthesia are often avoided for various reasons, particularly in elderly patients. In recent years, peripheral nerve block has proven effective in various surgical procedures. Additionally, dexmedetomidine exhibits neuroprotective effects and has been used safely in super-old patients. Herein, we demonstrate successful anaesthetic management with peripheral nerve block under dexmedetomidine sedation for open reduction and internal fixation of a femoral neck fracture in a 97-year-old patient.

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Section: Discussionmentioning

confidence: 84%

Successful peripheral nerve block under dexmedetomidine sedation for femoral neck fracture fixation in a 97-year-old patient

et al. 2021

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“…A previous study of patients who underwent diabetic foot surgery showed that the incidence of significant hypotension was higher in the spinal anaesthesia group than in the popliteal block group. 8 Therefore, anaesthesia using PNB may be a suitable choice to maintain haemodynamic stability and the analgesic effect.…”

Section: Discussionmentioning

confidence: 99%

Successful use of ultrasound-guided peripheral nerve block for lower limb surgery in a patient with heart failure with reduced ejection fraction: a case report

et al. 2021

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The number of patients with heart failure with reduced ejection fraction (HFrEF) is increasing. These patients have a reduced cardiorespiratory reserve. Therefore, preoperative evaluation is essential to determine the best type of anaesthesia to use in patients with HFrEF. A 70-year-old man with HFrEF was scheduled to undergo debridement of skin necrosis due to thrombotic occlusion of the right common iliac artery. He had undergone wound dressing changes under local anaesthesia every other day for several months, and treatment for heart failure was on-going. A sciatic nerve and fascia iliaca compartment block was performed under ultrasound guidance because of the patient’s cardiopulmonary function. After confirming adequate sensory blockage, surgery was performed without any haemodynamic instability or complications. Thereafter, debridement was performed twice more using the same block technique, and a skin autograft was also successfully performed. We successfully performed an ultrasound-guided sciatic nerve and fascia iliaca compartment block in a patient with HFrEF who was scheduled to undergo lower limb surgery. Peripheral nerve block is an alternative option for patients with HFrEF.

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“…Previous studies reported superiority of PNB over spinal anesthesia in patients with diabetes mellitus. 17 However, there are few reports that study the rate of nerve injuries and their recovery in patients with diabetes receiving dexamethasone in PNBs, mostly based on the lack of evidence. 30 It is also well known that patients with previous neuropathy are more likely to have progression of a neurological complication utilizing a ropivacaine-only PNB.…”

Section: Discussionmentioning

confidence: 99%

Effect of Dexamethasone in Peripheral Nerve Blocks on Recovery of Nerve Function

et al. 2020

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Background: Peripheral nerve blocks (PNBs) have revolutionized distal extremity surgery reducing pain and improving hospital efficiency. Perineural dexamethasone has been administered with PNBs to prolong their effects, although the safety of dexamethasone has not been established in the literature. This study aimed to determine if the addition of dexamethasone affected the postoperative neurological sensory status for foot and ankle surgeries and the recovery of nerve injuries. We hypothesized that the rate of persistent nerve injury would be higher in the dexamethasone group. Methods: This is a retrospective observational cohort study of prospectively collected data of all patients from a single foot and ankle surgeon’s practice. Perineural dexamethasone was routinely used as an adjunct by the regional anesthesia group until a clinical trend of increased paresthesia was found on short-term follow-up, which led to the discontinuation of its use. In this study, the cohort that received dexamethasone with ropivacaine was compared with the cohort that received ropivacaine alone. The primary outcome was a separate sensory nerve status sheet that was completed for every distal nerve territory for every patient at their follow-up visits at 2 weeks, 6 weeks, 3 months, and 6 months. Univariate analysis and a logistic regression model were used to determine the association between dexamethasone and delayed nerve recovery. A total of 250 patients were included in the study, with 117 patients in the dexamethasone group and 133 in the ropivacaine-only group. Results: The rates of nerve injuries were not different between the groups (72 [62%] in the dexamethasone group vs 79 [59%] in the ropivacaine-only group). However, nerve injury symptoms were more likely to persist and not fully recover in the dexamethasone group ( n = 47, 65%) compared with the ropivacaine-only group ( n = 32, 41%) (OR, 2.12; P = .006). Conclusion: Perineural dexamethasone added to PNBs may be associated with delayed nerve recovery after foot and ankle surgery. It may be prudent to avoid its use until its full safety profile is established in larger prospective trials. Level of Evidence: Level III, retrospective comparative study.

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The hemodynamic and pain impact of peripheral nerve block versus spinal anesthesia in diabetic patients undergoing diabetic foot surgery

Abstract: Clinical trial registry: ClinicalTrials.gov. ID NCT02727348.

Cited by 18 publications

References 23 publications

Successful peripheral nerve block under dexmedetomidine sedation for femoral neck fracture fixation in a 97-year-old patient

Successful peripheral nerve block under dexmedetomidine sedation for femoral neck fracture fixation in a 97-year-old patient

Successful use of ultrasound-guided peripheral nerve block for lower limb surgery in a patient with heart failure with reduced ejection fraction: a case report

Effect of Dexamethasone in Peripheral Nerve Blocks on Recovery of Nerve Function

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