Önen Özdemir Sibel, Şahiner Yeliz, Kayır Selçuk, Doğan Güvenç, Akdağlı Ekici Arzu, Çiçek Dal Gökçe, Kısa Alperen
Hitit University Erol Olçok Training and Research Hospital, Department of Anesthesiology and Reanimation, Çorum, Turkey.
Gaziantep Medical Point Hospital, Department of Anesthesiology and Reanimation, Gaziantep, Turkey.
Heliyon. 2024 Jul 14;10(14):e34620. doi: 10.1016/j.heliyon.2024.e34620. eCollection 2024 Jul 30.
In patients undergoing surgery due to diabetic foot complications from uncontrolled diabetes may lead to neuraxial or general anesthesia-related issues. Regional anesthesia techniques can be preferred to prevent these complications. This study aimed to compare the hemodynamic effects and outcomes in terms of pain of continuous infusion and single injection methods of popliteal nerve block in patients undergoing surgery due to diabetic foot.
Sixty-three patients in ASA II-IV risk group scheduled for diabetic foot surgery were randomized into two groups for popliteal nerve block as the anesthesia method. Group 1 (n:32), 30 mL of local anesthetic was administered around the popliteal nerve under ultrasound guidance and nerve stimulator. Group 2 (n:31) had a catheter placed beyond the needle tip by 4-5 cm. An elastomeric pump was prepared for the infusion of 2 mL/h of 0.25 % bupivacaine through the catheter. Hemodynamic parameters before and after the block, onset, block duration times, postoperative pain scores, time to analgesic requirement, patient satisfaction, and discharge time were recorded.
Pain scores were higher in Group 1 after 12 h postoperatively and in Group 2 after 60 h postoperatively (p = 0.006, p < 0.01, respectively). The time to the first analgesic requirement was not statistically different between Group 1 (mean 804.64 ± 1020.8 min) and Group 2 (mean 2012.78 ± 1424 min) (p = 0.072). There was no significant difference in systolic, diastolic, mean arterial blood pressure, and heart rate between groups before and after successful blockade (p > 0.05).
Continuous infusion method of popliteal nerve block provides a longer pain-free period. Both methods showed similar hemodynamic data and low pain scores. Although continuous infusion method provides better analgesia, its procedural cost, technical difficulties, and adverse effects on patient comfort should also be considered.
因糖尿病足并发症接受手术的患者，未得到控制的糖尿病可能导致神经轴索或全身麻醉相关问题。区域麻醉技术可能更有助于预防这些并发症。本研究旨在比较糖尿病足手术患者腘窝神经阻滞连续输注法和单次注射法在血流动力学效应及疼痛方面的结果。
将63例计划行糖尿病足手术的ASA II-IV风险组患者随机分为两组，采用腘窝神经阻滞作为麻醉方法。第1组（n = 32），在超声引导和神经刺激器辅助下，于腘窝神经周围注射30 mL局部麻醉药。第2组（n = 31），将导管置于针尖后方4-5 cm处。准备一个弹性泵，通过导管以2 mL/h的速度输注0.25%布比卡因。记录阻滞前后的血流动力学参数、起效时间、阻滞持续时间、术后疼痛评分、首次需要镇痛的时间、患者满意度及出院时间。
术后12 h时第1组疼痛评分较高，术后60 h时第2组疼痛评分较高（分别为p = 0.006，p < 0.01）。第1组（平均804.64 ± 1020.8分钟）和第2组（平均2012.78 ± 1424分钟）首次需要镇痛的时间在统计学上无差异（p = 0.072）。成功阻滞后两组间收缩压、舒张压、平均动脉血压及心率无显著差异（p > 0.05）。
腘窝神经阻滞连续输注法可提供更长的无痛期。两种方法的血流动力学数据相似且疼痛评分较低。虽然连续输注法镇痛效果更好，但也应考虑其操作成本、技术难度及对患者舒适度的不良影响。
