THE EFFECTIVENESS OF NEURAXIAL ANESTHESIA TECHNIQUES IN DIABETIC FOOT SURGERY

Introduction. Common is considered that surgical procedures in patients with diabetes mellitus (DM) must be performed at a stable level of blood glucose and at a stable hemodynamic. Aim. Determine effective anesthesia technique for diabetic foot (DF).surgery. Materials and methods. 30 patients (59.5 (53; 67) yr old, 16 female and 14 male) with DM and DF surgery were included in a retrospective study. Spinal anesthesia was used in 10 patients (SA group). In the presence of contraindications to spinal anesthesia we used the blockade of the sciatic nerve (SNB group, 10 patients), or general anesthesia with tracheal intubation (GA group, 10 patients). Data are presented as median (25th, 75th percentile). Results. In the SA group mean arterial pressure (MAP) decreased from baseline by more than 20% in 80% of patients, in the SNB group - in 30% (p = 0,03) and in the GA group - in 60% of patients (ns). The median of maximum decrease in MAP during anesthesia was 25 (20; 27)% for the SA group, 16 (13; 22)% for the SNB group (p = 0,03) and 21 (15; 24)% for the GA group (ns). Infusion volume was lower In SNB group than in the SA group (500 (500; 750) vs 1500 (1500; 2000) ml, p<0,001) and in the GA group (750 (750, 1000), p<0,001). Glucose levels increased during surgery above baseline in SA group by 6.1 (3.3; 14.3)% and in the GA group by 3 (4,5; 6)%. While in a SNB group glucose levels decreased by 5 (1.5, 14)% (a significant difference to the GA and SA groups). Conclusion. We found that anesthesia with sciatic nerve blockade is characterized by the minor influence on hemodynamics and glucose metabolism during DF surgery

diabetes mellitus, diabetic foot, surgery, anesthesia