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

Détails

ID Serval
serval:BIB_9EFAB21FA280
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Comparison of peripheral nerve blockade characteristics between non-diabetic patients and patients suffering from diabetic neuropathy: a prospective cohort study.
Périodique
Anaesthesia
Auteur(s)
Baeriswyl M., Taffé P., Kirkham K.R., Bathory I., Rancati V., Crevoisier X., Cherix S., Albrecht E.
ISSN
1365-2044 (Electronic)
ISSN-L
0003-2409
Statut éditorial
Publié
Date de publication
09/2018
Peer-reviewed
Oui
Volume
73
Numéro
9
Pages
1110-1117
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
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.
Mots-clé
Adult, Aged, Aged, 80 and over, Analgesics, Opioid/administration & dosage, Anesthetics, Local/administration & dosage, Anesthetics, Local/pharmacology, Case-Control Studies, Diabetes Mellitus, Type 2/complications, Diabetes Mellitus, Type 2/physiopathology, Diabetic Foot/etiology, Diabetic Foot/physiopathology, Diabetic Foot/surgery, Drug Administration Schedule, Female, Foot/surgery, Humans, Male, Middle Aged, Nerve Block/methods, Pain Measurement/methods, Pain, Postoperative/prevention & control, Prospective Studies, Sciatic Nerve/diagnostic imaging, Sciatic Nerve/drug effects, Sciatic Nerve/physiopathology, Sensation/drug effects, Time Factors, Ultrasonography, Interventional, Young Adult, analgesia, diabetes mellitus, peripheral nerve block
Pubmed
Web of science
Création de la notice
15/06/2018 18:01
Dernière modification de la notice
20/08/2019 16:05
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