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Future Considerations for Pharmacologic Adjuvants in Single-Injection Peripheral Nerve Blocks for Patients With Diabetes Mellitus
  1. Brian A. Williams, MD, MBA*,
  2. Beth B. Murinson, MD, MS, PhD,
  3. Benjamin R. Grable, MD and
  4. Steven L. Orebaugh, MD*
  1. From the *Department of Anesthesiology, University of Pittsburgh Medical Center South Side, University of Pittsburgh, Pittsburgh, PA;
  2. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; and
  3. Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA.
  1. Address correspondence to: Brian A. Williams, MD, MBA, Department of Anesthesiology, UPMC South Side, Suite 2302 2000 Mary St, Pittsburgh, PA 15203 (e-mail: williamsba{at}


Abstract As the epidemics of obesity and diabetes expand, there are more patients with these disorders requiring elective surgery. For surgery on the extremities, peripheral nerve blocks have become a highly favorable anesthetic option when compared with general anesthesia. Peripheral blocks reduce respiratory and cardiac stresses, while potentially mitigating untreated peripheral pain that can foster physiologic conditions that increase risks for general health complications. However, local anesthetics are generally accepted to be a rare but possible cause of nerve damage, and there are no evidence-based recommendations for dosing local anesthetic nerve blocks in patients with diabetes. This is important because anesthesiologists do not want to potentially accelerate peripheral nerve dysfunction in diabetic patients at risk. This translational vignette (i) examines laboratory models of diabetes, (ii) summarizes the pharmacology of perineural adjuvants (epinephrine, clonidine, buprenorphine, midazolam, tramadol, and dexamethasone), and (iii) identifies areas that warrant further research to determine viability of monotherapy or combination therapy for peripheral nerve analgesia in diabetic patients. Conceivably, future translational research regarding peripheral nerve blocks in diabetic patients may logically include study of nontoxic injectable analgesic adjuvants, in combination, to provide desired analgesia, while possibly avoiding peripheral nerve toxicity that diabetic animal models have exhibited when exposed to traditional local anesthetics.

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  • Dr. Williams is supported by departmental sources and by National Institutes of Health grant 1K01DA025146. Dr. Murinson is supported by departmental sources and by National Institutes of Health grant 5K08NS48146. Drs. Grable and Orebaugh are supported by departmental sources.

  • Reprints will not be available from the authors.