The Difference In Duration Of Sciatic Nerve Block Between Diabetic And Non-Diabetic Patients

INTRODUCTIONRegional anesthesia is commonly used in surgery on the extremities. The sensory and motor recovery time is a major clinical concern, and has a close relationship with postoperative analgesia and rehabilitation regimen. With the increasing prevalence of diabetes, diabetic patients are more frequently seen in our operating rooms. It has become a recent focus that diabetes may affect regional anesthesia including block onset time, duration, and the incidence of nerve injury. This study aims to compare the sensory and motor block duration and the incidence of nerve injury after sciatic nerve block between diabetic and non-diabetic patients, and screen for the factors that may affect the block recovery.METHODSAfter acquiring approval from the ethics committee of Peking Union Medical College Hospital, patients who were scheduled for unilateral lower limb surgery and met both the inclusion and exclusion criteria, were consecutively enrolled and assigned to either diabetic group or non-diabetic group according to their past medical history. Groups were not created until it came to the screening of affecting factors. Before surgery, the base values of the sensory threshold in the area innervated by the sciatic nerve (dorsal side, plantar side) were checked with Semmes Weinstein monofilaments (SWM). Fasting blood glucose, glycosylated hemoglobin (hemoglobin A1c, HbA1c) and the staging of diabetic retinopathy were also recorded. All patients received an ultrasound-guided (nerve stimulator assisted) subgluteal sciatic nerve block with 0.75% ropivacaine 20ml. The sensory and motor blocks were assessed every 2 hours in 48 hours after the block, except for the second night. SWM test was used to assess sensory recovery. Dorsiflexion and plantar flexion were used to evaluate the motor recovery. The primary end point was the sensory and motor block duration.RESULTSOver the study period,53 cases were enrolled with 16 diabetic patients and 37 non-diabetic patients. No significant differences were found between the two groups regarding the demographic data except for older age and higher ASA classification in diabetic group. Fasting blood glucose and HbAlc were significantly higher in the diabetic group. The sensory block duration was redefined as the full recovery of SWM test on dorsal side and plantar side of the foot to preoperative level because the data-missing rate of lateral calf sensation was 39.6% due to surgical dressing. The diabetic patients had similar sensory block duration (16 h vs.16 h) but significantly longer motor block duration (21 h vs.16 h) compared with non-diabetic patients. After performing regression analysis for all cases, we found significant positive correlation between motor block duration and preoperative fasting blood glucose, but not with HbAlc. The factors that may be related to sensory block duration are gender, preoperative sensory threshold, block performance time, local anesthetic spread, and ALT. The factors that may be related to motor block duration are TBil, DBil, and Cr.CONCLUSIONSComparing with non-diabetic patients, the diabetic patients undergoing minor vascular or orthopedic surgery in lower extremities showed prolonged motor recovery but similar sensory recovery after single-shot sciatic nerve block. The motor block duration is closely related to fasting blood glucose. Other possible factors related to the durations are gender, preoperative sensory threshold, block performance time, and local anesthetic spread, liver and kidney functions.OBJECTIVETo investigate the effect of ulinastatin (Urinary Trypsin Inhibitor, UTI) on patients’ perioperative inflammatory response, postoperative acute and chronic pain, and the recovery of knee joint function after bilateral total knee arthroplasty (TKA) under pneumatic tourniquet.METHODS40 patients scheduled to receive bilateral TKA under thigh tourniquet were enrolled and randomly assigned to trial group (U group) and control group (C group). U group received intravenous ulinastatin and C group received saline at identical time points. All patients received the same general anesthesia, postoperative analgesia and physical therapy. The plasma concentration of inflammatory cytokines, such as IL-6, TNF-α, and IL-10, were tested at different time points. The patient’s VAS pain scores at rest and activity, the opioid consumption, the range of active knee flexion and continuous passive motion, and the time consumed by walking for a 30-meter distance were observed and compared.RESULTSNo significant differences were found between two groups regarding the demographic data. The level of postoperative inflammatory response of U group was lower than C group. The VAS at rest and motion, and sufentanil consumption at 4 hours after the surgery of U group were significantly lower than C group. No statistically significant difference was found in postoperative functional recovery parameters at all time points.CONCLUSIONSThe application of ulinastatin in bilateral TKA alleviates perioperative inflammatory response, decreases early postoperative resting pain scores, reduces opioid consumption, but does not significantly affect the restoration of knee joint function.