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Original article
Sex-dependent prolongation of sciatic nerve blockade in diabetes patients: a prospective cohort study
  1. Shuai Tang1,
  2. Jin Wang1,
  3. Yi Tian1,
  4. Xu Li1,
  5. Qiuju Cui2,
  6. Mei Xu2,
  7. Xiaojun Song3,
  8. Yuehong Zheng3,
  9. Hongbo Yang4,
  10. Chao Ma5,
  11. Lujing Zhan6,
  12. Chaonan Zhu7,
  13. Yuelun Zhang8,
  14. Min Yao9 and
  15. Yuguang Huang1
  1. 1 Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  2. 2 Operating Room, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  3. 3 Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  4. 4 Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  5. 5 Department of Anatomy, Histology and Embryology, Institute of Basic Medical Sciences, Chinese Academy of MedicalSciences and Peking Union Medical College, Beijing, China
  6. 6 Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
  7. 7 Chronic Disease Research Institute, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
  8. 8 Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  9. 9 Department of Surgery, Wound Care Clinical Research Program, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA
  1. Correspondence to Dr Yuguang Huang, Department of Anesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; garypumch{at}163.com; Dr Min Yao; minyao99{at}hotmail.com

Abstract

Introduction Diabetes may affect the duration of nerve block after regional anesthesia. This study aimed to compare the durations of sensory and motor block in diabetes versus non-diabetes patients after lower limb nerve block and delineate any sex-based differences in the duration of sensory and motor blocks of both diabetes and non-diabetes patients.

Methods This prospective single-blinded cohort study recruited 86 patients who underwent unilateral lower extremity surgery; 52 patients were non-diabetic and 34 were diabetic. Each patient received an ultrasound-guided nerve stimulator-assisted subgluteal sciatic nerve block with 0.75% ropivacaine. Duration of sensory block was assessed with the Semmes-Weinstein monofilament test, and duration of motor block was assessed with dorsal and plantar flexion of the foot.

Results The sensory and motor block durations of diabetes patients were significantly prolonged versus non-diabetes patients (19.8±6.0 hours vs 15.6±5.1 hours; p<0.05) and (19.5±8.1 hours vs 14.8±5.7 hours, p=0.005), respectively. The durations of sensory and motor block were comparable between male diabetes and non-diabetes patients, but they were significantly longer in female diabetes patients. Multiple regression analysis further revealed that, after adjustment for age and preoperative sensory threshold, diabetes, fasting plasma glucose and HbA1c levels were significantly associated with sensory and motor blocks. Sex analysis showed the association was only present in female diabetes patients, not male diabetes patients.

Conclusion The durations of sensory and motor block are significantly prolonged after subgluteal sciatic nerve block in diabetes patients. Furthermore, the prolonged nerve blockade is present only in diabetes women, not diabetes men.

Trial registration number NCT02482831.

  • lower extremity
  • postoperative pain
  • interventional pain management

https://doi.org/10.1136/rapm-2019-100609

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    Footnotes

    • MY and YH contributed equally.

    • Contributors Conceived and designed the experiment: YH, MY, CM and ST. Performed the experiment: ST, XL, QC, MX, XS, YuehZ, HY and YT. Analyzed the data: ST, MY, LZ, CZ, YuelZ, JW and YT. Contributed to the writing of the manuscript: ST, JW, YT, MY, LZ and YH. Reviewed the manuscript: YH, MY, CM, MX, XS, YuehZ and HY.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication The study protocol was approved by the Peking Union Medical College Hospital (No. ZS-804). The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Verbal informed consent for publication was obtained from all the authors.

    • Ethics approval Informed written consent was obtained before enrollment of every patient. The study protocol was approved by the Ethics Committee of Peking Union Medical College Hospital, ref. n. ZS-804.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.