Jacobs Journal of Anesthesiology and Research

Influence of Diabetes Mellitus on Ultrasound-Guided Supraclavicular Nerve Block Duration: A Retrospective Observational Study

*Katarina Tomulic Brusich
Department Of Anesthesiology And Intensive Care Medicine, School Of Medicine, University Hospital Merkur, Zagreb, Croatia

*Corresponding Author:
Katarina Tomulic Brusich
Department Of Anesthesiology And Intensive Care Medicine, School Of Medicine, University Hospital Merkur, Zagreb, Croatia
Email:ktomulic@gmail.com

Published on: 2018-07-24

Abstract

Background: The incidence and prevalence of obesity, metabolic syndrome and diabetes mellitus (DM) is rapidly increasing in modern society. Number of these patients carrying this burden requiring elective or emergency surgery is also increasing. The aim of this study is to establish the possible differences in diabetic (DM) and non-DM patients regarding dose requirements for ultrasound-guided supraclavicular nerve block (SCB). Methods: Retrospective evaluation of department records identified a total of 120 SCB procedures performed at University Hospital Merkur Zagreb between May 2009 and March 2013. Demographic data, co-morbidities and block performance data i.e. type and volumes of local anesthetic (LA) were collected in order to investigate whether DM influences block duration. A multivariate analysis was performed to identify predictor variables associated with prolonged block duration. Results: Significant differences were noted in ASA status (DM had higher ASA score, P<0,001) and in coronary artery disease (CAD) prevalence (P=0,036). Multivariate linear regression model analyzed duration of SCB using two significantly relevant predictor variables: use of lidocaine + levobupivacaine mixture (beta=-0,276, P=0,005) and DM (beta=0,243, P=0,017). DM patients had longer block duration, as well as those who received “pure” levobupivacaine. Conclusion: According to our study, DM patients have longer block duration which implies that their nerve fibers might be more susceptible to LA. Relationship between the dose, volume, and concentration of LA remains unclear. Our suggestion is to use smaller volumes of LA in diabetic patients, preferably those with shorter duration time and to use ultrasound to avoid nerve damage.

Keywords

Nerve Blocks; Ultrasound Imaging; Diabetes Mellitus

Introduction

The incidence and prevalence of obesity, metabolic syndrome and diabetes mellitus (DM) is rapidly increasing in modern society. Number of these patients requiring elective or emergency surgery is also increasing. Peripheral nerve blocks (PNB) have become a popular anesthetic option for the extremities surgery, because they provide better postoperative analgesia than general anesthesia does, while avoiding the cardiopulmonary and insulin-resistance effects of general anesthesia. Therefore, PNB are useful even for patients with DM. Nevertheless, little has been written regarding the implications of DM on PNB used for surgical anesthesia-analgesia. Increasing incidence of DM and metabolic syndrome means that regional anesthesia specialists need to re-evaluate and potentially improve perioperative anesthetic care for diabetic patients undergoing limb surgery.