Kim Na-Eun, Lee Woo-Joo, Jung Jong-Kwon, Song Jang-Ho, Joa Kyung-Lim, Yang Chun-Woo, Jung Eui-Chan, Jo Soo-Man, Ko Yeong-Seung
The Department of Anesthesiology and Pain Medicine, School of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, Republic of Korea.
The Department of Public Health Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
J Pers Med. 2024 Mar 27;14(4):353. doi: 10.3390/jpm14040353.
Nerves in patients with diabetic neuropathy (DN) show increased susceptibility to local anesthetics, potentially requiring a decreased dose. We investigated whether the minimum effective anesthetic concentration (MEAC) of mepivacaine for successful axillary block is lower in patients with DN than in those without. This prospective observational study included patients with DN ( = 22) and without diabetes ( = 22) at a tertiary care center. Patients received an ultrasound-guided axillary block with 30 mL of mepivacaine for anesthesia. The mepivacaine concentration used in each patient was calculated using Dixon's up-and-down method. A block was considered successful if all four sensory nerves had a score of 1 or 2 within 30 min with no pain during surgery. The primary outcome was the MEAC of mepivacaine, and the secondary outcomes included the minimal nerve stimulation intensity for the musculocutaneous nerve and the occurrence of adverse events. The MEAC was 0.55% (95% CI 0.33-0.77%) in patients without diabetes and 0.58% (95% CI 0.39-0.77%) in patients with DN ( = 0.837). The MEAC was 0.98% (95% CI 0.54-1.42%) in patients without diabetes and 0.96% (95% CI 0.57-1.35%) in patients with DN ( = 0.949). The stimulation threshold for the musculocutaneous nerve was significantly different between groups (0.49 mA vs. 0.19 mA for patients with vs. without diabetes; = 0.002). In conclusion, the MEAC of mepivacaine for a successful axillary block is not lower in patients with DN.
糖尿病性神经病变（DN）患者的神经对局麻药的敏感性增加，可能需要减少剂量。我们研究了在进行腋路阻滞时，DN患者成功实施阻滞所需的甲哌卡因最低有效麻醉浓度（MEAC）是否低于非DN患者。这项前瞻性观察性研究纳入了一家三级医疗中心的DN患者（n = 22）和非糖尿病患者（n = 22）。患者接受了30 mL甲哌卡因的超声引导下腋路阻滞麻醉。每位患者使用的甲哌卡因浓度采用Dixon上下法计算。如果所有四条感觉神经在30分钟内评分为1或2，且手术期间无疼痛，则认为阻滞成功。主要结局是甲哌卡因的MEAC，次要结局包括肌皮神经的最小神经刺激强度和不良事件的发生情况。非糖尿病患者的MEAC为0.55%（95%CI 0.33 - 0.77%），DN患者为0.58%（95%CI 0.39 - 0.77%）（P = 0.837）。非糖尿病患者的MEAC为0.98%（95%CI 0.54 - 1.42%），DN患者为0.96%（95%CI 0.57 - 1.35%）（P = 0.949）。两组之间肌皮神经的刺激阈值有显著差异（糖尿病患者与非糖尿病患者分别为0.49 mA对0.19 mA；P = 0.002）。总之，对于成功的腋路阻滞，DN患者的甲哌卡因MEAC并不更低。
