ABSTRACT
OBJECTIVE: Diabetic neuropathy is one of the most common complications of diabetes mellitus. Recovery from peripheral nerve blocks in diabetic patients with neuropathy may be delayed because of axonal degeneration and segmental demyelination. The aim of this study is to compare the infraclavicular brachial plexus block durations in patients with and without diabetes mellitus type 2. METHODS: This prospective observational study included 60 patients who were aged 40-80 years, with American Society of Anesthesiologists I-IV physical status and scheduled for elbow, forearm, and/or hand surgery under infraclavicular brachial plexus blocks. All 30 patients in Group DM (patients with diabetes mellitus type 2 diagnosis) and 29/30 patients in Group NODM (patients without diabetes mellitus diagnosis) completed the study successfully. The sensorial block duration was documented as the primary outcome, and the motor block duration, time-to-first pain, numeric rating scale scores at rest/during mobilization, rescue analgesic use, and total consumed doses through the first 2 postoperative days were all documented as the secondary outcomes. RESULTS: Sensorial block duration in Group DM (505 [315-1020] minutes) was longer than in Group NODM (440 [160-780] minutes) (P =.016). Motor block duration was also longer (488.7 ± 153.8 minutes vs 379.2 ± 118.9 minutes; P =.003), and time-to-first pain was prolonged (625 [360-1200] minutes vs 520 [300-900] minutes; P =.004) in Group DM. The highest NRS scores at the 6th hours, 12th hours, and rescue analgesic consumption through the first 2 postoperative days were lower in Group DM (P < .05). CONCLUSION: This infraclavicular brachial plexus block study highlights the current literature on diabetic patients with respect to longer block durations, prolonged time-to-first pain, lower pain scores, and less analgesic consumption.
ABSTRACT
Performing a block under ultrasound guidance effectively requires skill; however, inexperienced anesthesiologists often use high-dose LA to ensure success. We aimed to share our experience with the ultrasound-guided infraclavicular brachial plexus block (USGICB) for upper extremity surgeries and to determine changes in failure rate and local anesthetic dose administered with gaining adequate experience. With approval from the local ethics committee, a retrospective review of records of 2953 patients who underwent USGICB between November 2011 and March 2015 was performed for evaluating the following data: age, sex, height, weight, operation type, American Society of Anesthesiologists physical status score, local anesthetic volume, complications, and success of USGICB. The patients were divided into 4 groups of 10 months each from November 2011 to March 2015: first 10-month period, 628 cases (group I); second 10-month period, 672 (group II); third 10-month period, 720 (group III); and the fourth 10-month period, 933 cases (group IV). Nine anesthesiologists with the same baseline experience in USG performed the blocks. During the initial period, when anesthesiologists had insufficient experience, local anesthetic (LA) dose, success rate, failed blocks, and complications were investigated. The LA volume administered in group I (33.7 ± 4.2 ml) was significantly higher than that in groups II, III, and IV (p < 0.05). Although a reduction in LA volume administered with increasing anesthesiologist experience was not statistically significant, a volume reduction of over 30 ml was observed in groups II, III, and IV compared with group I. Furthermore, in group I, failure rate (3.2%) was higher than that in groups II, III, and IV (p < 0.05). We concluded that sonographic guidance ensures a high success rate and that increased experience of anesthesiologists is associated with reduced complications and failure rate of blocks, in addition to prevention of LA overdose.
