Department of Anesthesiology and Pain Management, Centre Hospitalo-Universitaire Carémeau, Place du Professeur Debré, Nîmes, France.
Br J Anaesth. 2013 May;110(5):823-30. doi: 10.1093/bja/aes496. Epub 2013 Jan 24.
Although animal studies demonstrated delayed recovery after nerve block in laboratory models of diabetes, the duration of the action of sciatic nerve blocks clinically in patients with diabetes remains to be determined. We studied the duration of a sciatic nerve block in type 2 diabetic patients compared with non-diabetic patients.
We prospectively included consecutive patients aged 50-80 yr, with type 2 diabetes with minor nerve injury (confirmed with 5.07 at 10 g monofilament test, n=23) and non-diabetic patients (n=49) scheduled for distal lower limb surgery. Before surgery, a subgluteal sciatic nerve block (20 ml of ropivacaine 4.75 mg ml(-1)) was performed with an ultrasound approach coupled with nerve stimulation. The primary endpoint was the sensory block duration.
There was no significant difference between groups for age, but haemoglobin A1c and creatinine values were significantly higher in the diabetic group. There was no difference in 5.07 (10 g) monofilament testing, but the diabetic group had lower scores for the 0.4 and 0.07 g tests (P<0.01). There was no significant difference in the median onset time for the sensory block (25 vs 25 min, NS), but the median duration of the sensory block (21 vs 17 h, P<0.01) and the motor block (16 vs 12 h, P<0.01) were higher in the diabetic group. No complication occurred in either group.
These findings demonstrate that diabetic patients with pre-existing incipient neuropathy exhibit delayed recovery from the block with ropivacaine, confirming animal studies. Clinical trial registration ClinicalTrials.gov, NCT01704612.
尽管动物研究表明，在糖尿病的实验室模型中，神经阻滞后恢复延迟，但在糖尿病患者中坐骨神经阻滞的临床作用持续时间仍有待确定。我们研究了 2 型糖尿病患者与非糖尿病患者坐骨神经阻滞的持续时间。
我们前瞻性纳入了年龄在 50-80 岁之间、有轻微神经损伤的 2 型糖尿病患者（用 5.07 号 10 g 单丝试验证实，n=23）和非糖尿病患者（n=49），这些患者计划接受下肢远端手术。手术前，在超声引导下联合神经刺激进行臀下坐骨神经阻滞（20 ml 罗哌卡因 4.75 mg/ml）。主要终点是感觉阻滞持续时间。
两组间年龄无显著差异，但糖尿病组的血红蛋白 A1c 和肌酐值显著升高。5.07 号（10 g）单丝试验无差异，但糖尿病组 0.4 和 0.07 g 试验评分较低（P<0.01）。感觉阻滞的中位起效时间无显著差异（25 与 25 min，NS），但糖尿病组感觉阻滞（21 与 17 h，P<0.01）和运动阻滞（16 与 12 h，P<0.01）的中位持续时间较长。两组均无并发症发生。
这些发现表明，存在前驱神经病变的糖尿病患者对罗哌卡因阻滞的恢复延迟，证实了动物研究的结果。临床试验注册ClinicalTrials.gov，NCT01704612。
