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

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Abstract

Purpose

Comparison of hemodynamic profiles and pain scores in diabetic patients undergoing diabetic foot surgery receiving peripheral nerve block (PNB) or spinal anesthesia [subarachnoid block (SAB)].

Methods

This was a prospective, randomised controlled trial. We recruited diabetic patients aged > 18 years, American Society of Anesthesiologists class II–III, who were scheduled for unilateral diabetic foot surgery below the knee. All patients were assessed for autonomic dysfunction using the Survey of Autonomic Symptoms score. Participants were randomly assigned to receive either PNB or SAB for the surgery. Hemodynamic data, including usage of vasopressors, were recorded at 5-min intervals for up to 1 h after the induction of anesthesia. Pain scores were recorded postoperatively, and follow-up was done via telephone 6 months later.

Results

Compared to the PNB group, the SAB group had a larger number of patients with significant hypotension (14 vs. 1; p = 0.001) and more patients who required vasopressor boluses (6 vs. 0 patients). Compared to SAB group, the patients in the PNB group had a longer postoperative pain-free duration (9 vs. 4.54 h; p = 0.002) and lower pain scores 1 day after surgery (3.63 vs. 4.69; p = 0.01).

Conclusion

Peripheral nerve block should be considered, whenever possible, as the first option of anesthesia for lower limb surgery in diabetic patients as it provides hemodynamic stability and superior postoperative pain control compared to SAB.

Trial registration

Clinical trial registry: ClinicalTrials.gov. ID NCT02727348.

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Authors and Affiliations

  1. Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia

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

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  1. Hou Yee Lai
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  2. Li Lian Foo
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  3. Siu Min Lim
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  4. Chen Fei Yong
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  5. Pui San Loh
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  7. Mohd Shahnaz Hasan
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Correspondence to Sook Hui Chaw.

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All authors declare that they have no conflict of interest to declare.

Funding

No external funding was received for this study.

Informed consent

Informed consent was obtained from all individual participants in the study.

Ethical approval

This study was conducted in compliance with ethical standards.

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Lai, H.Y., Foo, L.L., Lim, S.M. et al. The hemodynamic and pain impact of peripheral nerve block versus spinal anesthesia in diabetic patients undergoing diabetic foot surgery. Clin Auton Res 30, 53–60 (2020). https://doi.org/10.1007/s10286-017-0485-8

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  • DOI: https://doi.org/10.1007/s10286-017-0485-8

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