Diabetes mellitus is a systemic disease that affects peripheral nerves. The use of regional anaesthesia in diabetic patients undergoing surgery can be unpredictable. We investigated the efficacy of brachial plexus block (BPB) in diabetic patients compared to nondiabetic individuals.
Methods
Four hundred and six patients were included. Forty-six patients were diabetic: 20 with type 1, 22 with type 2 and four with diet-controlled diabetes. A mixture of 0.5% bupivacaine and 1% prilocaine was used. Postoperative proximal and distal, motor and sensory functions were assessed. Motor function was assessed using the Medical Research Council grading system. Sensory function was assessed using a graded scale.
Results
In diabetic patients, the BPB was as efficient for proximal motor (p = 0.25) and sensory (p = 0.33) blocks as it was in nondiabetic patients. There was a significant difference in the efficacy of the block distally between diabetic and nondiabetic patients in both motor (p = 0.007) and sensory function (p = 0.001). The efficacy of the BPB was poorer in diabetic patients.
Conclusions
A BPB can be used efficiently for shoulder surgery in diabetic patients. For distal surgery, surgeons and anaesthetists should be prepared to reinforce the block or use general anaesthesia.
HeblJR, KoppSL, SchroederDR, HorlockerTT. Neurologic complications after neuraxial anesthesia or analgesia in patients with preexisting peripheral sensorimotor neuropathy or diabetic polyneuropathy. Anesth Analg2006; 103: 1294–9.
2.
RossMA. Neuropathies associated with diabetes. Med Clin North Am1993; 77: 111–24.
3.
DyckPJ, KratzKM, KarnesJL. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology1993; 43: 817–24.
SchiffRL, EmanueleMA. The surgical patient with diabetes mellitus: guidelines for management. J Gen Intern Med1995; 10: 154–61.
6.
McAnultyGR, RobertshawHJ, HallGM. Anaesthetic management of patients with diabetes mellitus. Br J Anaesth2000; 85: 80–90.
7.
Medical Research Council of the United Kingdom.Aids to examination of the peripheral nervous system: memorandum no. 45.Palo Alto, CA: Pedragon House, 1978.
8.
National Research Ethics Service.National patient safety agency.http://www.nres.npsa.nhs.uk/ (date last accessed 30 April 2011).
9.
AgrestiACategorical data analysis, 2nd edn.Hoboken, NJ: Wiley-Blackwell, 2002.
PowellHC, RosoffJ, MyersRR. Microangiopathy in human diabetic neuropathy. Acta Neuropathol [Berl]1985; 68: 295–305.
16.
CameronNE, CotterMA, LowPA. Nerve blood flow in early experimental diabetes in rats: relation to conduction deficits. Am J Physiol1991; 261: E1–8.
17.
KocumA, TurkozA, BozdoganN, CaliskanE, EkerEH, ArslanG. Femoral and sciatic nerve block with 0.25% bupivacaine for surgical management of diabetic foot syndrome: an anesthetic technique for high-risk patients with diabetic nephropathy. J Clin Anesth2010; 22: 363–66.
18.
FrancoCD. Upper extremity blocks. In: FrancoCD ed. Manual of regional anaesthesia, 2nd edn.Chicago: JHS Hospital of Cook County, 2007:60–80.
19.
MonnierVM, KohnRR, CeramiA. Accelerated age-related browning of human collagen in diabetes mellitus. Proc Natl Acad Sci USA1984; 81: 583–7.
20.
SchniderSL, KohnRR. Effects of age and diabetes mellitus on the solubility and nonenzymatic glucosylation of human skin collagen. J Clin Invest1981; 67: 1630–5.
21.
SchniderSL, KohnRR. Glucosylation of human collagen in aging and diabetes mellitus. J Clin Invest1981; 66: 1179–81.
22.
ChangK, UittoJ, RowoldEA, GrantGA, KiloC, WilliamsonJR. Increased collagen cross-linkages in experimental diabetes: reversal by beta-aminopropionitrile and D-penicillamine. Diabetes1980; 29: 778–81.
23.
KannelWB, McGeeDL. Diabetes and cardiovascular disease. The Framingham study. JAMA1979; 241: 2035–8.
24.
SchuylerMR, NiewoehnerDE, InkleySR, KohnR. Abnormal lung elasticity in juvenile diabetes mellitus. Am Rev Respir Dis1976; 113: 37–41.
25.
PillsbuiryHC, HungW, KyleMC, FreisED. Arterial pulse wave velocity and systolic time intervals in diabetic children. Am Heart J1974; 87: 783–90.
26.
WatersJH, WatsonTB, WardMG. Conus medullaris injury following both tetracaine and lidocaine spinal anesthesia. J Clin Anesth1996; 8: 656–8.
27.
HorlockerTT, O'DriscollSW, DinapoliRP. Recurring brachial plexus neuropathy in a diabetic patient after shoulder surgery and continuous interscalene block. Anesth Analg2000; 91: 688–90.
28.
HeblJR, HorlockerTT, SorensonEJ, SchroederDR. Regional anesthesia does not increase the risk of postoperative neuropathy in patients undergoing ulnar nerve transposition. Anesth Analg2001; 93: 1606–11.
29.
KrishnanAV, KiernanMC. Altered nerve excitability properties in established diabetic neuropathy. Brain2005; 128: 1178–87.
