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The influence of diabetic neuropathy on the current settings during peripheral nerve stimulation for peripheral regional anesthesia
- Abstract
- The prevalence of diabetes mellitus (DM) in industrialized countries is estimated to be about 7.3% and its incidence has been growing in recent years. The prevalence of diabetic neuropathy in the diabetic patient population is up to 50%. When limb surgery is necessary, it is reasonable to assume that diabetic patients will benefit from a regional anesthetic because of the severe comorbidities associated with DM. On the other hand, the use of regional anesthesia (RA) has generally not been recommended in patients with preexisting neuropathies mainly because of medical liability issues, as worsening neuropathy could be attributed to nerve damage caused by the regional anesthetic. The current state of the art of peripheral regional anesthesia for the identification of correct placement of an injection needle suitably close to the target nerve is to elicit a motor response by current injection through the needle. Constant reduction of the current as the nerve is approached ensures close proximity so that an effective nerve block is obtained when the local anesthetic is delivered through the needle, and absence of a motor response at 0.3 mA is generally accepted as a safety marker to avoid harmful intraneural injection. An important deficit in our understanding is whether diabetic neuropathy influences the stimulation parameters for peripheral nerve stimulation (PNS), possibly decreasing safety.
The currently proposed research is guided by the hypothesis that nerves in patients with DM are resistant to stimulation and, as a consequence, the current thresholds for PNS have to be set much higher to prevent injections from occurring within the epineurium. We will examine this the effect of DM on nerve excitability in a blinded, prospective, observational case control trial. Accordingly, we have defined following aims:
Aim 1: To characterize the required stimulation current in patients with and without diabetes mellitus.
Aim 2: Follow-up to examine if the rate of adverse neurologic events is higher in diabetic patients.
Aim 3: Guided by the results, formulate recommendations for the performance of regional anesthesia in patients with a history of DM.
These experiments will provide better understanding of the needle-current-nerve relationship during peripheral nerve stimulation. Findings from this proposed study will have a major impact on patient safety, especially in the subgroup with preexisting neuropathy, undergoing regional anesthesia
- Keywords
- neuropathology
- diabetology
- anaesthesiology
- Diabetische Neuropathie
- Periphere Nervenstimulation
- Periphere Regionalanästhesie
- Project Leader:
- Rigaud Marcel
- Duration:
- 01.01.2012-30.09.2013
- Programme:
- KLIF
- Subprogramme
- KLIF
- Type of Research
- clinical trial
- Further information: http://www.fwf.ac.at/de/abstracts/abstract.asp?L=D&PROJ=KLI135
- Staff
- Rigaud, Marcel, Project Leader
- Gemes, Geza, Sub Projectleader
- Heschl, Stefan, Sub Projectleader
- Köhler, Gerd, Co-worker
- Leb-Stöger, Ulrike, Co-worker
- Hallmann, Barbara, Co-worker