Surgical peripheral nerve decompression for the treatment of painful diabetic neuropathy of the foot - A level 1 pragmatic randomized controlled trial.

AIMS: To assess the efficacy of surgical decompression of lower extremity nerves for the treatment of painful diabetic peripheral sensorimotor polyneuropathy (DPN). METHODS: People with painful diabetic neuropathy were randomized single-blind to a lower extremity decompression surgery (n = 12) or observation (n = 10) for 1 year. RESULTS: Pain was the primary outcome assessed with 2 measures. The McGill pain visual analogue scores over time changed within the groups (p for time < 0.0001), and changed differently over time within the groups (p for group × time = 0.0138). The NeuroQoL pain sensitivity analysis significantly changed from baseline to 12 months comparing intervention to control (p = 0.0079), and the joint effect of group and time on pain scores was statistically significant (p for group × time = 0.0009). At the study end-point of 12 months, intervention group participants had over 3 times the odds of rating their pain as "better" compared to "unchanged" or "worse" in the control group (p = 0.0177). CONCLUSIONS: Surgical decompression of lower limb nerves was an effective treatment for decreasing pain in patients with DPN and superimposed nerve compressions.

Buffered lidocaine and bupivacaine mixture - the ideal local anesthetic solution?

The use of injectable local anesthetic solutions to facilitate pain-free surgery is an integral component of many procedures performed by the plastic surgeon. In many instances, a solution that has both rapid onset and prolonged duration of analgesia is optimal. A combination of lidocaine and bupivacaine, plain or with epinephrine, is readily available in most Canadian health care settings where such procedures are performed, and fulfills these criteria. However, commercially available solutions of both medications are acidic and cause a burning sensation on injection. Buffering to neutral pH with sodium bicarbonate is a practical method to mitigate the burning sensation, and has the added benefit of increasing the fraction of nonionized lipid soluble drug available. The authors report on the proportions of the three drugs to yield a neutral pH, and the results of an initial survey regarding the use of the combined solution with epinephrine in hand surgery.

L'injection d'anesthésiques injectables locaux pour favoriser une opération sans douleur fait partie intégrante des nombreuses interventions réalisées par le plasticien. Dans bien des cas, une solution analgésique à action longue et rapide est optimale. Une bithérapie de lidocaïne et de bupivacaïne, seule ou accompagnée d'adrénaline, disponible dans la plupart des milieux de santé canadiens où de telles interventions sont effectuées, respecte ce critère. Les solutions commerciales de ces deux médicaments sont toutefois acides et provoquent une sensation de brûlure à l'injection. L'utilisation d'un tampon de bicarbonate de sodium pour obtenir un pH neutre est pratique pour limiter la sensation de brûlure et a l'avantage supplémentaire d'accroître la fraction de médicament liposoluble non ionisé disponible. Les auteurs rendent compte des proportions des trois médicaments nécessaires pour obtenir un pH neutre et des résultats d'un sondage initial sur l'utilisation de la bithérapie combinée à l'adrénaline pour la chirurgie de la main.