Clinical Study On The Effects Of Different Anesthesia Methods On Perioperative Hemodynamics And Prognosis Of Lower Extremity Surgery In Patients With Diabetic Foot

Studies have shown that different anesthesia methods can have a significant impact on perioperative blood pressure and complications,and may also have a corresponding impact on long-term prognosis and outcomes of patients,but it is unclear whether this conclusion applies to those who receive patients with diabetic foot surgery.This study is a retrospective combined prospective study of the effects of different anesthesia methods on perioperative hemodynamics and prognosis in patients with diabetic foot.The results showed that nerve block used for lower extremity surgical anesthesia in diabetic patients has little effect on the patient’s physiological function,can significantly reduce the incidence of intraoperative hypotension and the use of vasopressors,has good circulatory stability,and nerve block can also significantly reduce the occurrence of postoperative pain and the use of rescue analgesics in patients.In order to confirm the safety of nerve block anesthesia for diabetic patients,this experiment further conducted a prospective cohort study comparing the characteristics of lower extremity nerve block in non-diabetic patients and diabetic patients.We found that diabetic patients had higher peripheral nerve minimal stimulation thresholds,longer duration of nerve block,and longer duration of first postoperative rescue analgesia.No higher rates of nerve damage were observed in the diabetic group than in the non-diabetic group.Our research is divided into three parts as shown below.Part Ⅰ A retrospective study on the effects of different anesthesia methods on perioperative hemodynamics and prognosis in patients with diabetic footObjective To compare the effects of general anesthesia and nerve block anesthesia on perioperative hydrodynamic changes and prognosis in patients with diabetic foot surgery.Methods A retrospective cohort method was used in this study.The patients who met the inclusion criteria were divided into two groups according to different anesthesia methods:The general anesthesia group(GA group)and the nerve block anesthesia group(PNB group),there were 125 cases in the general anesthesia group and 212 cases in the nerve block anesthesia group.The case information of patients with diabetes and diabetic foot who underwent lower extremity surgery between July 2016 and June 2020 was collected using the His medical electronic system and the care anesthesia clinical information system.The general information of patients such as gender,age,height,weight,ethnicity,education,and place of residence was recorded.We also record the patient’s preoperative biochemical test results including blood routine,liver and kidney function,blood lipids,etc.Changes in vital signs of the two groups of patients were recorded at 4-time points:entering the room(T0),induction intubation or nerve block puncture(T1),skin incision(T2),10 minutes after skin incision(T3),and at the end of the operation(T4)and the length of surgery is also recorded.Finally,the use of postoperative rescue analgesics,postoperative complications such as pneumonia,ICU transfer,nausea,etc.,and length of hospital stay were recorded.Results The results showed that there was no significant difference between the two groups in general information such as gender,BMI,ethnicity,education level,and place of residence(P>0.05).When compared with the GA group,the average age and the disability rate of patients in the PNB group was higher than the GA group(P<0.05).The comparison of coexisting diseases between the two groups showed that the number of coronary heart disease,diabetic nephropathy,uremia,and diabetic neuropathy was higher in the PNB group(P<0.05).The systolic blood pressure(SBP),diastolic blood pressure(DBP),and mean arterial pressure(MAP)of patients in the GA group were lower than those in the PNB group at time points T1,T2,T3,and T4(P<0.05).Meanwhile,the incidence of intraoperative hypotension and the use of vasopressors in the GA group were significantly higher than those in the PNB group(P<0.05).The use rate of postoperative rescue analgesics in the GA group was significantly higher than that in the PNB group(P<0.05).At last,there was no significant difference in postoperative complications between the two groups(P>0.05).Conclusions Nerve block for lower extremity surgical anesthesia in diabetic patients has the advantage of less impact on the patient’s circulation,reducing the incidence of intraoperative hypotension and the use of vasopressors.In addition,nerve block anesthesia can also reduce postoperative pain and reduce the amount of rescue pain medication.Nerve blocks can provide safe and effective perioperative analgesia for diabetic lower extremity surgery patients.General anesthesia has a greater impact on circulation,and the incidence of perioperative hypotension is high.However,the prognosis of the two groups of patients,such as mortality,ICU admission rate,was not statistically different.Part Ⅱ Prospective study on the effects of different anesthesia methods on perioperative hemodynamics and prognosis in patients with diabetic footObjective To compare the effects of general anesthesia and nerve block anesthesia on perioperative hydrodynamic changes and prognosis of lower extremity surgery in patients with diabetic foot.Methods A randomized double-blind control method was used.Patients who met the criteria were randomly divided into the general anesthesia group(group GA)and nerve block anesthesia group(group PNB)with 62 cases in the GA group and 87 cases in the PNB group.The patients in the PNB group were anesthetized by ultrasound-guided femoral nerve combined with a sciatic nerve block.After ultrasound localization of the sciatic nerve,the operator wears sterile gloves and routinely disinfects the puncture site.2ml 2%lidocaine was used for local infiltration anesthesia,neurostimulator current is reduced when muscle movement is observed until a minimum stimulation current can be observed.After confirming the position of the needle tip then instruct the assistant to inject 20ml of 0.5%ropivacaine at a slow speed.A femoral nerve block is performed in the same way.Five minutes after the end of the nerve block operation,the effect of the block was confirmed by acupuncture.Patients in the GA group received total intravenous anesthesia and endotracheal intubation.During the operation,the target-controlled infusion(TCI)of propofol and remifentanil was set at the minimum speed under the condition of maintaining the bispectral index(BIS)of 40-60,and the stable vital signs,ephedrine or norepinephrine are used when patients occur hypotension.The patient was transferred to an anesthesia recovery unit(PACU)for anesthesia resuscitation after the operation was completed.The preoperative data and preoperative examination results of the two groups of patients were recorded.The use of postoperative rescue analgesics,first food intake,first exercise time,and the length of hospital stay was recorded.Changes in vital signs of the two groups of patients were recorded at 4-time points:entering the room(T0),induction intubation or nerve block puncture(T1),skin incision(T2),bone transformation or debridement(T3),and at the end of the operation(T4).The Mini-Cog scare was used to record the cognitive function of patients on the day before surgery and three consecutive days after surgery.Frail scale was used to record whether the patient has a state of frailty and the degree of frailty before surgery.The Brief Pain Inventory(BPI)was used to record chronic pain lasting 3 months or more before surgery.Michigan Neuropathy Screening Tool for Diabetic Peripheral Neuropathy in Two Groups of Patients.The Amsterdam Preoperative Anxiety Information Scale(APAIS)was used to assess patients’preoperative anxiety state and the ED-5Q quality of life assessment scale was used to assess the quality of life of patients on the day before surgery and three consecutive days after surgery.HUAWEI 4e standard version sports smart bracelet is used to monitor the sleep quality of patients,including the total sleep time,light sleep time,deep sleep time,and the number of awakenings at night one day before surgery and two days after surgery.Results The outcomes revealed that there was no significant difference in the general data of age,gender,BMI,education status,length of hospital stay et al.between the two groups(P>0.05).At the same time,we observe that there was no significant difference in preoperative examination results,preoperative coexisting diseases,cardiopulmonary function assessment,MNSI score,FRAIL Scale score,APAIS score,and MiniCog score between the two groups(P>0.05).However,we found that the systolic blood pressure(SBP),diastolic blood pressure(DBP)and mean arterial pressure(MAP)of patients in the GA group were significantly lower than those in the PNB group at time points T1,T2,and T3 and the incidence of intraoperative hypotension was a significantly higher in the GA group than in the PNB group(P<0.05).On the first and second days after surgery,we observed that the total sleep time and deep sleep time in the PNB group were significantly higher than those in the GA group(P<0.05).In addition,the proportion of patients who used postoperative rescue analgesics in the GA group was significantly higher than that in the PNB group(P<0.05).The ratio of patients who take the first movement after operation in the PNB group was higher than that in the GA group,and the time of the first intake in the PNB group was shorter than that in the GA group(P<0.05).There was no sore throat in the PNB group,and 10 patients in the GA group complained of sore throat(P<0.05).Conclusions Ultrasound-guided femoral nerve combined with sciatic nerve block for diabetic foot lower extremity surgery patients with better circulatory stabilization when compared to general anesthesia.Nerve block can reduce the incidence of postoperative pain and the use of rescue analgesics in patients.it also reduces the occurrence of postoperative adverse reactions and significantly improves the sleep quality and hospitalization satisfaction of patients.General anesthesia has a greater impact on the circulation of patients,the incidence of perioperative hypotension is higher,and the postoperative pain score and sleep quality are worse than those of nerve block anesthesia.However,there were no statistically significant differences in outcomes such as mortality and ICU admission rates between the two groups.Part Ⅲ Comparison of the characteristics of lower extremity nerve blocks in non-diabetic and diabetic patients:a prospective cohort studyObjective To investigate the effect of nerve block on postoperative neurological function in non-diabetic and diabetic patients by measuring the minimum nerve stimulation threshold and the duration of nerve block in non-diabetic and diabetic patients.Methods This is a prospective cohort study.Patients who met the criteria were divided into a non-diabetic group(N-DM group)and a diabetic group(DM group)with 48 cases in the N-DM group and 83 cases in the DM group.Both groups of patients received nerve block anesthesia before surgery.Nerve block was performed in combination with a neurostimulator under ultrasound guidance,the initial current of the neurostimulator was set to 1.0mA,the pulse width was 0.1ms and the stimulation frequency was 1Hz.When a typical peroneal nerve motor response(foot dorsiflexion or valgus)or quadriceps muscle movement was observed,the minimum threshold for nerve stimulation was recorded.After the injection of local anesthetic,the motor block and the sensory block were assessed by another observer at 2-min intervals.The skin temperature of the middle tibia,dorsum of the foot,and sole and medial malleolus of the affected limb were measured with a thermal imager before and after the nerve block.The preoperative general information and intraoperative and postoperative general conditions of the two groups were recorded.The minimum nerve stimulation threshold,nerve block duration,and lower limb skin temperature before and after nerve block were recorded.The area and circumference of the sciatic nerve,tibial nerve,common peroneal nerve,posterior tibial nerve,and median nerve were measured by ultrasound.The MNSI scale and the TSSC scale were used to assess the presence of peripheral neuropathy in the two groups.Meanwhile,the frail scale and APAIS scale were used to evaluate preoperative weakness and anxiety in the two groups of patients.Results There was no significant difference in general data such as age,gender,and BMI between the two groups(P>0.05).The disability rate in the DM group was higher than that in the N-DM group.In addition,more patients in the DM group had ASA grade 3 or above than in the N-DM group(P<0.05).There were significant differences in blood routine,liver function,renal function,and blood lipids between the DM group and the N-DM group(P<0.05).The proportion of preoperative coexisting diseases such as hypertension,coronary heart disease,and cerebral infarction in the DM group was higher than that in the N-DM group(P<0.05).The MNSI score,TCSS score,and Frail score in the DN group were significantly higher than those in the N-DM group(P<0.05).The femoral nerve and sciatic nerve stimulation thresholds in the DM group were higher than those in the N-DM group,and the duration of femoral nerve block and sciatic nerve block in the DM group was significantly longer than those in the N-DM group(P<0.05).The area and circumference of the sciatic nerve,tibial nerve,common peroneal nerve,posterior tibial nerve and median nerve measured by ultrasound in the DM group were larger than those in the N-DM group(P<0.05).The number of patients in the N-DM group who required the use of tramadol for postoperative rescue analgesia was more than that in the DM group,and the length of hospital stay in the DM group was longer than that in the N-DM group(P<0.05).Conclusions Diabetic patients have a higher minimum stimulation threshold of peripheral nerves,longer duration of nerve block,and longer duration of first postoperative rescue analgesia.