Mettitus and Subclinical Neuropathy.

摘要

PERIPHERAL nerve blocks have become a popular anesthetic option in the perioperative management of patients with diabetes mellitus (types 1 and 2) because blocks provide better postoperative analgesia than does general anesthesia, while avoiding the cardiopulmonary and insulin-resistance effects of general anesthesia. Despite widespread clinical application of peripheral nerve blocks, important limits persist in our knowledge regarding their use in these patients. First, whether local anesthetics themselves are more toxic to peripheral nerves in diabetic and other preneuropathic patients is unknown, although this has been suggested by a recent report of sensorimotor nerve damage for patients with previously undiagnosed polyneuropathy.1 Second, we do not know whether the dose of local anesthetic for effective peripheral nerve block differs in the presence of diabetes mellitus. Third, a recent report suggests that standard (nerve stimulator) approaches to localizing nerves for injection exhibit reduced effectiveness in diabetic patients.2#