Department of Anesthesiology, Academic Medical Center, University of Amsterdam, The Netherlands -
Minerva Anestesiol. 2013 Sep;79(9):1039-48. Epub 2013 May 6.
Diabetic peripheral neuropathy (DPN) is a frequent complication of longstanding diabetes mellitus. There is no evidence-based consensus whether neuropathic patients undergoing peripheral regional anesthesia are at increased risk of neurologic damage. It is unknown whether these controversial results have been incorporated into clinical practice. We conducted a survey to test the hypothesis that the majority of respondents would consider DPN a potential risk factor for nerve damage in regional anesthesia, and would adapt their technique when performing regional anesthesia. In parallel, we sought to summarize the current knowledge-base regarding regional anesthesia and DPN.
We therefore performed 1) a literature search to review current literature and 2) an online computer-based survey among members of the European Society of Regional Anesthesia and Pain Therapy (ESRA).
The overall response rate was 19% (584 responders/3107 invitations). About a quarter of participants would avoid regional anesthesia in patients with diabetic neuropathy, and 59% of respondents would counsel patients with diabetic neuropathy about increased risk of regional anesthesia. When techniques were modified, most participants would decrease or omit epinephrine, while fewer respondents would decrease dose of local anesthetic or perform other adjustments. More than 80% agreed with the statement that nerve blocks could be performed safely in diabetic neuropathic patients.
In conclusion, we report the results of the first survey analyzing attitudes and standards of care among European anesthesiologists with regards to regional anesthesia in DPN. While literature is divided on the question whether pre-existing diabetic neuropathy is a risk factor for new neurological deficit after regional anesthesia, most of the responders of this survey take measures to reduce risks, counsel patients on a possible greater risk of neurologic complications, but only a minority of responders would avoid peripheral regional anesthesia altogether.
糖尿病周围神经病变（DPN）是糖尿病长期存在的常见并发症。目前尚无循证共识表明行周围区域麻醉的神经病变患者是否存在神经损伤风险增加。尚不清楚这些有争议的结果是否已纳入临床实践。我们进行了一项调查，以检验以下假设：大多数受访者认为 DPN 是区域麻醉中神经损伤的潜在危险因素，并在进行区域麻醉时调整技术。同时，我们试图总结目前关于区域麻醉和 DPN 的知识基础。
因此，我们进行了 1）文献检索以审查当前文献，和 2）在欧洲区域麻醉和疼痛治疗学会（ESRA）成员中进行在线计算机调查。
总回复率为 19%（584 名受访者/3107 名邀请）。约四分之一的参与者会避免对糖尿病神经病患者进行区域麻醉，59%的受访者会告知糖尿病神经病患者区域麻醉的风险增加。当改变技术时，大多数参与者会减少或省略肾上腺素，而较少的受访者会减少局部麻醉剂的剂量或进行其他调整。超过 80%的受访者同意这样的说法，即神经阻滞可以安全地用于糖尿病神经病变患者。
总之，我们报告了首次调查的结果，该调查分析了欧洲麻醉师在 DPN 中进行区域麻醉的态度和护理标准。尽管文献在预先存在的糖尿病神经病是否是区域麻醉后新发神经功能缺损的危险因素这一问题上存在分歧，但该调查的大多数受访者采取措施降低风险，告知患者神经并发症风险增加，但只有少数受访者会完全避免外周区域麻醉。
