Introduction

Hindfoot surgery is assumed to be more painful than midfoot/forefoot procedures with the former often requiring an inpatient stay for pain relief. Poorly controlled pain is associated with adverse patient outcomes and consequently, peripheral nerve blocks (PNB) have become popular for their effective pain control.

Introduction

Brachial plexus blocks are used widely to provide intra-operative and post-operative analgesia. Their efficacy is well established, but little is known about discharging patients with a numb or weak arm. We need to quantify the risk of complications for improved informed consent.

Introduction: Diabetes mellitus is a systemic disease affecting peripheral nerves and the use of regional anaesthesia in diabetic patients undergoing surgery could be unpredictable. We investigated the efficacy of brachial plexus block in diabetic patients undergoing upper limb surgery compared to normal individuals.

Method: Four hundred and fifty-two patients had a brachial plexus block performed under ultra-sound guidance by senior anaesthetists. There were 221 males and 231 females. Fifty-five patients were diabetic (mean age of 61 years, SD 12), 24 with type 1 and 31 with type 2 diabetes. Mean age of non-diabetic patients was 55 years (SD 15). A mixture of 0.5% Bupivacaine and 1% Prilocaine was used for the block. Post-operative proximal and distal motor and sensory functions were assessed. The assessment was conducted at a mean of 4.6 hours (SD 2.2 hours) post-operatively. MRC grading system was used to asses motor function while sensory function was assessed subjectively using a graded scale between 0, absent sensation, 1, altered sensation and 2, normal sensation.

Results: Brachial plexus block was as efficient in diabetic patients proximally for motor and sensory functions compared to non-diabetic patients. There was significant difference in the efficacy of the block distally between diabetic and non-diabetic patients in both motor (P< 001) and sensory function (P< 0001). Furthermore, in diabetic patients the response to the block between type 1 and type 2 was statistically significant (P< 001).

Conclusion: In diabetes, the efficacy of brachial plexus block is different compared to normal individuals. This study showed that brachial plexus block can be used efficiently in shoulder surgery in patients with diabetes. In more distal surgery, orthopaedic surgeons as well as anaesthetists should be prepared to either reinforce the block by using a local anaesthetic or to convert to general anaesthesia, if necessary, in diabetic patients.

Introduction: Diabetes mellitus is a systemic disease that is known to affect peripheral nerves. The use of regional anaesthesia in diabetic patients undergoing surgery could be unpredictable. We investigated the efficacy of brachial plexus block in diabetic patients undergoing upper limb surgery compared to normal individuals.

Methods: Four hundred and fifty-two patients were included in the study. There were 221 males and 231 females. Fifty-five patients were diabetic (mean age of 61ys, SD 12), 24 were type 1 and 31 were type 2 diabetes. Mean age of non-diabetic patients was 55 (SD15). Senior Anaesthetists performed all brachial plexus block under ultra-sound guidance. A mixture of 10 ml of 0.5% Bupivacaine and 10 ml of 1% Xilocaine was used for the block. Post-operative motor and sensory function assessment was conducted at a mean time of 4.57 hours (SD 2.19 hours). MRC grading system was used to asses motor function while sensory function was assessed subjectively using a graded scale between 0 and 2 with 0 being absent sensation, 1 being altered sensation and 2 indicated normal sensations. The assessment was conducted proximally and distally.

Results: Brachial plexus block was as efficient in diabetic patients proximally for motor and sensory functions compared to non-diabetic patients. There was significant difference in the efficacy of the block distally between diabetic and non-diabetic patients in both motor (P< .001) and sensory function (P< .001). Furthermore, in diabetic patients the response to the block between type 1 and type 2 was statistically significant (P< .001).

Conclusion: Diabetic patients are at increased morbidity and mortality risks following general anaesthesia and therefore, regional block is a favorable option in these patients. In diabetes, the efficacy of brachial plexus block is different compare to normal individuals. This study showed that brachial plexus block can be used efficiently in shoulder surgery in patients with diabetes. In more distal surgery, orthopaedic surgeons as well as anaesthetists should be prepared to either reinforce the block by using a local anaesthetic or to convert to general anaesthesia, if necessary, in diabetic patients