International Journal of Pharma and Bio Sciences
    ISSN 0975-6299

Int J Pharm Bio Sci Volume 12 Issue 1, 2021 (January-March), Pages:16-20

Local anesthetic drugs in popliteal sciatic nerve blocks for patients with established diabetic neuropathy – Do no harm!

Dr. Avijit Chanda, Dr. Balachandar.S and Dr. Parthasarathy.S

Diabetes mellitus is a common endocrine disease with India leading the world in prevalence of the disease. Patients with Diabetes Mellitus present with foot surgeries with proven neuropathies. A complete search of the Pubmed, Cochrane and Scopus databases was done for the articles on the safety of the local anaesthetic drugs inside the nerve with established neuropathy. Relevant articles with their methodologies were analysed. Patients with long term diabetes mellitus have multiple other comorbidities; administration of either General or neuraxial technique of anaesthesia may not be favoured. Autonomic imbalance and hemodynamic instability in central neuraxial blockade happen in such cases. The problem of airway control, presence of organ dysfunction may make general anaesthesia an unfriendly choice. Hence, blocking the sciatic nerve in the popliteal site is very popular in these patients. The advent of ultrasound and a better knowledge of extra neural injections is advantageous in these patients with known neuropathy. It has also made the action to be more definite with decreased dosage of drugs.  The concept of double crush phenomenon of additional damage caused by local anaesthetics is not clinically very significant. Local anaesthetics as plain solutions seem to be better than mixing with additives with unknown toxic potential. Given the pros and cons, the targeted ultrasound guided nerve blocks seem to be advantageous with negligible side effects.

Keywords: diabetes mellitus, neuropathy, nerve block, drugs, local aesthetics
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