Salviz Emine Aysu, Onbasi Sukru, Ozonur Anil, Orhan-Sungur Mukadder, Berkoz Omer, Tugrul Kamil Mehmet
Department of Anesthesiology, Division of Hand, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Department of Anesthesiology, Division of Hand, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
J Hand Surg Am. 2017 Mar;42(3):190-197. doi: 10.1016/j.jhsa.2017.01.009.
Patients with diabetes mellitus (DM) type 2 may have subclinical peripheral nerve neuropathy. We performed this study to compare the differences in duration of axillary brachial plexus blocks in patients with type 2 DM and without DM (NODM). Our hypothesis was that the sensory block duration would be prolonged in patients with DM.
A total of 71 patients who were scheduled for elective forearm and/or hand surgery were enrolled in this study. Before surgery, they received ultrasound-guided axillary brachial plexus blocks with a mixture of 10 mL lidocaine 2% and 20 mL bupivacaine 0.5%. After surgery, all patients received 1 g paracetamol every 6 hours as needed. The primary end point was sensory block duration. Secondary end points were motor block duration, time until first pain (numeric rating scale [NRS] 4 or greater), highest NRS pain scores, and rescue analgesic consumption (NRS 4 or greater) through the first 2 postoperative days.
In all, 67 patients completed the study: 22 in the DM group and 45 in the NODM group. Sensory and motor block durations were longer in the DM group than in the NODM group (mean [range], 773.5 [479-1155] vs 375 [113-900] minutes, and 523 [205-955] vs 300 [110-680] minutes). Time until first pain was 855 (590-1,285) minutes in the DM group and 500 (200-990) minutes in the NODM group. The highest NRS scores were also significantly lower in the DM group at 6 and 12 hours. Paracetamol consumption was lower in the DM group through the first 2 postoperative days.
The presence of DM was associated with longer duration of the sensory block after axillary brachial plexus block.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
2型糖尿病（DM）患者可能存在亚临床周围神经病变。我们进行本研究以比较2型糖尿病患者和非糖尿病（NODM）患者腋路臂丛神经阻滞持续时间的差异。我们的假设是糖尿病患者的感觉阻滞持续时间会延长。
本研究共纳入71例计划行择期前臂和/或手部手术的患者。手术前，他们接受了超声引导下的腋路臂丛神经阻滞，使用10 mL 2%利多卡因和20 mL 0.5%布比卡因的混合液。手术后，所有患者根据需要每6小时服用1 g对乙酰氨基酚。主要终点是感觉阻滞持续时间。次要终点是运动阻滞持续时间、首次疼痛时间（数字评分量表[NRS]为4或更高）、最高NRS疼痛评分以及术后前两天的补救镇痛药物消耗量（NRS为4或更高）。
共有67例患者完成了研究：糖尿病组22例，非糖尿病组45例。糖尿病组的感觉和运动阻滞持续时间比非糖尿病组更长（平均[范围]，773.5 [479 - 1155]分钟对375 [113 - 900]分钟，以及523 [205 - 955]分钟对300 [110 - 680]分钟）。糖尿病组的首次疼痛时间为855（590 - 1285）分钟，非糖尿病组为500（200 - 990）分钟。糖尿病组在6小时和12小时时的最高NRS评分也显著更低。术后前两天糖尿病组的对乙酰氨基酚消耗量更低。
糖尿病的存在与腋路臂丛神经阻滞后感觉阻滞持续时间延长有关。
研究类型/证据水平：治疗性II级。
