Журнал «Медицина неотложных состояний» Том 20, №4, 2024

Регіонарні методи анестезії широко застосовуються при оперативних втручаннях на нижній кінцівці, зокрема на стопі. Але на сьогодні недостатньо вивчені ризики, пов’язані з виконанням дистальних блокад у пацієнтів із цукровим діабетом. Нами було проаналізовано 30-денні наслідки блокування нервів гомілково-надп’яткового суглоба у 88 пацієнтів, яким були виконані оперативні втручання з приводу синдрому діабетичної стопи. Отримані результати свідчать про відсутність підвищеного ризику інфекційних і трофічних ускладнень у зоні виконання блокади в групі пацієнтів, яким виконувалась блокада нервів гомілково-надп’яткового суглоба, порівняно з групою підколінного блоку і групою спинномозкової анестезії. Частота повторних операцій вірогідно не відрізнялась у всіх трьох групах.

Regional methods of anesthesia are widely used in surgical interventions on the lower limb, in particular on the foot. But to date, the risks associated with performing distal blocks in patients with diabetes are insufficiently studied. We analyzed the 30-day consequences of tibiocalcaneal nerve block in 88 patients who underwent surgery for diabetic foot syndrome. The obtained results indicate the absence of an increased risk of infectious and trophic complications in the block area in the group of patients who underwent tibiocalcaneal nerve block compared to those with popliteal nerve block and the group of spinal anesthesia. The frequency of repeated operations was not significantly different in all 3 groups.

синдром діабетичної стопи; провідникова анестезія; регіонарна анестезія; місцевий анестетик; цукровий діабет; набряк

diabetic foot syndrome; conduction anesthesia; regional anesthesia; local anesthetic; diabetes; edema

1. Prompers L, Huijberts M, Schaper N, Apelqvist J, Bakker K, Edmonds M et al. Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study. Diabetologia. 2008 Oct;51(10):1826-34. doi: 10.1007/s00125-008-1089-6. Epub 2008 Jul 22. PMID: 18648766.
2. Schipper ON, Hunt KJ, Anderson RB, Davis WH, Jones CP, Cohen BE. Ankle Block vs Single-Shot Popliteal Fossa Block as Primary Anesthesia for Forefoot Operative Procedures: Prospective, Rando-mized Comparison. Foot Ankle Int. 2017 Nov;38(11):1188-1191. doi: 10.1177/1071100717723132. Epub 2017 Aug 17. PMID: 28814096. 
3. Dmytriiev D, Lysak Y, Glazov Y, Geranin SI, Zaletska O. Mini-invasive methods of treatment of diabetic foot pain. Pain medicine. 2019 Nov;4(3);4-50. DOI: 10.31636/pmjua.v4i3.1.
4. Rudkin GE, Rudkin AK, Dracopoulos GC. Bilateral ankle blocks: A prospective audit. ANZ Journal of Surgery. 2005;75(1-2):39-42. doi: 10.1111/j.1445-2197.2005.03286.x.
5. Cassuto J, Sinclair R, Bonderovic M. Anti-inflammatory pro-perties of local anesthetics and their present and potential clinical implications. Acta Anaesthesiol Scand. 2006 Mar;50(3):265-82. doi: 10.1111/j.1399-6576.2006.00936.x. PMID: 16480459.
6. MacGregor RR, Thorner RE, Wright DM. Lidocaine inhibits granulocyte adherence and prevents granulocyte delivery to inflammatory sites. Blood. 1980 Aug;56(2):203-9. PMID: 7397378.
7. Jeng CL, Torrillo TM, Rosenblatt MA. Complications of peripheral nerve blocks. British Journal of Anaesthesia. 2010;105 Suppl 1: i97-i107. https://doi.org/10.1093/bja/aeq273.
8. Alakkad H, Naeeni A, Chan VW, Abbas S, Oh J, Ami N, Ng J, Gardam M, Brull R. Infection related to ultrasound-guided single-injection peripheral nerve blockade: a decade of experience at Toronto Western hospital. Reg Anesth Pain Med. 2015 Jan-Feb;40(1):82-4. doi: 10.1097/AAP.0000000000000181. PMID: 25469758.
9. Barrington MJ, Watts SA, Gledhill SR, Thomas RD, Said SA, Snyder GL, Tay VS, Jamrozik K. Preliminary results of the Austra-lasian Regional Anaesthesia Collaboration: a prospective audit of more than 7000 peripheral nerve and plexus blocks for neurologic and other complications. Reg Anesth Pain Med. 2009 Nov-Dec;34(6):534-41. doi: 10.1097/aap.0b013e3181ae72e8. PMID: 19916206.
10. Capdevila Х, Bringuier S, Borgeat А, Riou B. Infectious Risk of Continuous Peripheral Nerve Blocks. Anesthesiology. 2009;110:182-188. doi: https://doi.org/10.1097/ALN.0b013e318190bd5b.
11. Fredrickson MJ, Kilfoyle DH. Neurological complication analysis of 1000 ultrasound guided peripheral nerve blocks for elective orthopaedic surgery: a prospective study. Anaesthesia. 2009 Aug;64(8):836-44. doi: 10.1111/j.1365-2044.2009.05938.x. PMID: 19604186.
12. Beaulieu RJ, Grimm JC, Lyu H, Abularrage CJ, Perler BA. Rates and predictors of readmission after minor lower extremity amputations. J Vasc Surg. 2015 Jul;62(1):101-5. doi: 10.1016/j.jvs.2015.02.021. Epub 2015 Mar 28. PMID: 25827965; PMCID: PMC4801218.
13. Szabó Z, Szentkirályi É, Kovács T, Győrffy Ö, Sütő B, Bátai I, Kerényi M. Helyi érzéstelenítők antibakteriális hatása [Antibacterial effect of local anaesthetics]. Orv Hetil. 2021 Jan 31;162(5):171-176. Hungarian. doi: 10.1556/650.2021.32002. PMID: 33517330.
14. Callahan ZM, Roberts AL, Christopher AN, Gadomski SP, Kuchta KM, Costanzo CM et al. The Effect of Commonly Used Local Anesthetic on Bacterial Growth. J Surg Res. 2022 Jun;274:16-22. doi: 10.1016/j.jss.2021.12.040. Epub 2022 Feb 1. PMID: 35114483.
15. Sakuragi T, Ishino H, Dan K. Bactericidal activity of clinically used local anesthetics on Staphylococcus aureus. Reg Anesth. 1996 May-Jun;21(3):239-42. PMID: 8744667.
16. Kesici S, Demirci M, Kesici U. Antibacterial effects of lidocaine and adrenaline. Int Wound J. 2019 Oct;16(5):1190-1194. doi: 10.1111/iwj.13182. Epub 2019 Aug 12. PMID: 31407479; PMCID: PMC7949267.
17. Dmytriiev D, Nazarchuk O, Faustova M, Babina Y, Dmytriiev K, Dobrovanov O, Králinský K. Local anesthetics contributing the struggling biofilm-forming activity of S. aureus colonizing surfaces of venous catheters. Multicenter clinical trial. 2021;70:21-24.
18. Hickey NC, Wilkes MP, Howes D, Watt J, Shearman CP. The effect of epidural anaesthesia on peripheral resistance and graft flow following femorodistal reconstruction. Eur J Vasc Endovasc Surg. 1995 Jan;9(1):93-6. doi: 10.1016/s1078-5884(05)80231-x. PMID: 7664020. 
19. Bozkurt M, Kulahci Y, Zor F, Sen H, Acikel CH, Deveci M, Turegun M, Sengezer M. Comparison of the effects of inhalation, epidural, spinal, and combined anesthesia techniques on rat cremaster muscle flap microcirculation. Microsurgery. 2010;30(1):55-60. doi: 10.1002/micr.20719. PMID: 19967761. 
20. Barrington MJ, Kluger R. Ultrasound guidance reduces the risk of local anesthetic systemic toxicity following peripheral nerve blockade. Reg Anesth Pain Med. 2013;38(4):289-299. doi: 10.1097/AAP.0b013e318299a74d
21. Sgarlato TE, Morgan JM, Patzakis MJ, Vasconcellos D. The use of epinephrine in foot and ankle surgery. Journal of Foot and Ankle Surgery. 2014;53(3):344-349. doi: 10.1053/j.jfas.2013.11.010.
22. Kesici S, Kesici U, Ulusoy H, Erturkuner P, Turkmen A, Arda O. Efeitos dos anestésicos locais na cicatrização de feridas [Effects of local anesthetics on wound healing]. Braz J Anesthesiol. 2018 Jul-Aug;68(4):375-382. doi: 10.1016/j.bjan.2018.01.016. Epub 2018 Jun 6. PMID: 29884529; PMCID: PMC9391713.
23. YaDeau JT, Brummett CM, Mayman DJ, Lin Y, Goytizolo EA, Padgett DE, Alexiades MM. Duloxetine and subacute pain after knee arthroplasty when added to a multimodal analgesic regimen: a randomized, placebo-controlled, triple-blinded trial. Anesthesia & Analgesia. 2013;116(3):625-632. doi: 10.1213/ANE.0b013e3182815d5a.
24. Memtsoudis SG, Sun X, Chiu Y-L, Stundner O, Liu SS, Banerjee S, Sharrock NE. Perioperative Comparative Effectiveness of Anesthetic Technique in Orthopedic Patients. Anesthesiology. 2013;118(5):1046-1058. doi: 10.1097/aln.0b013e318286061d.
25. Hicks CW, Selvin E. Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Curr Diab Rep. 2019 Aug 27;19(10):86. doi: 10.1007/s11892-019-1212-8. PMID: 31456118; PMCID: PMC6755905.
26. Balasubramanian GV, Chockalingam N, Naemi R. The Role of Cutaneous Microcirculatory Responses in Tissue Injury, Inflammation and Repair at the Foot in Diabetes. Front Bioeng Biotechnol. 2021 Sep 14;9:732753. doi: 10.3389/fbioe.2021.732753. PMID: 34595160; PMCID: PMC8476833.
27. Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care. 1990;13(5):513-521. doi: 10.2337/diacare.13.5.513.
28. Bakker K, Apelqvist J, Lipsky BA, Van Netten JJ, Schaper NC. The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: development of an evidence-based global consensus. Diabetes Metab Res Rev. 2016;32 Suppl 1:2-6. doi: 10.1002/dmrr.2694.
29. Ramsey SD, Newton K, Blough D et al. Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care. 1999;22(3):382-387. doi: 10.2337/diacare.22.3.382
30. Becker DE, Reed KL. Essentials of local anesthetic pharmacology. Anesth Prog. 2006 Fall;53(3):98-108; quiz 109-10. doi: 10.2344/0003-3006(2006)53 [98:EOLAP]2.0.CO;2. PMID: 17175824; PMCID: PMC1693664.
31. Lai HY, Foo LL, Lim SM, Yong CF, Loh PS, Chaw SH, Hasan MS, Wang CY. The hemodynamic and pain impact of peripheral nerve block versus spinal anesthesia in diabetic patients undergoing diabetic foot surgery. Clin Auton Res. 2020 Feb;30(1):53-60. doi: 10.1007/s10286-017-0485-8. Epub 2017 Dec 1. PMID: 29196938.
32. Tang S, Wang J, Tian Y, Li X, Cui Q, Xu M et al. Sex-dependent prolongation of sciatic nerve blockade in diabetes patients: a prospective cohort study. Reg Anesth Pain Med. 2019 Jul 12:rapm-2019-100609. doi: 10.1136/rapm-2019-100609. Epub ahead of print. PMID: 31302640.
33. Sun J, Feng X, Zhu Q, Lin W, Guo H, Ansong E, Liu L. Analgesic effect of perineural magnesium sulphate for sciatic nerve block for diabetic toe amputation: A randomized trial. PLoS One. 2017 May 2;12(5):e0176589. doi: 10.1371/journal.pone.0176589. PMID: 28464014; PMCID: PMC5413065.
34. Dmytriiev D, Prudius P, Zaletskaya O, Lisak Y, Rudnitsky Y, Korenchuk N. Neuropathic pain: mechanisms of development, principles of diagnostics and treatment. Pain medicine. 2019;4(2):4-32. DOI: https://doi.org/10.31636/pmjua.v4i2.1.
35. Dmytriiev D, Lisak Y, Zaletska O. Adjuvants in pain medicine. Selection of the drug depending on the desired effect — so which drug to choose? Pain medicine. 2020;5(2):4-14. DOI: https://doi.org/10.31636/pmjua.v5i2.1.
36. Ilfeld BM, Duke KB, Donohue MC. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg. 2010 Dec;111(6):1552-4. doi: 10.1213/ANE.0b013e3181fb9507. Epub 2010 Oct 1. PMID: 20889937; PMCID: PMC3271722.
37. Volmer-Thole M, Lobmann R. Neuropathy and Diabetic Foot Syndrome. Int J Mol Sci. 2016 Jun 10;17(6):917. doi: 10.3390/ijms17060917. PMID: 27294922; PMCID: PMC4926450.
38. Primadhi RA. Susceptibility Factors for Early Reamputation in Diabetic Great Toe Gangrene. Curr Diabetes Rev. 2021;17(1):55-62. doi: 10.2174/1573399816666200224100608. PMID: 32091343.
39. Cheun TJ, Jayakumar L, Sideman MJ, Ferrer L, Mitromaras C, Miserlis D, Davies MG. Short-term contemporary outcomes for staged versus primary lower limb amputation in diabetic foot disease. J Vasc Surg. 2020 Aug;72(2):658-666.e2. doi: 10.1016/j.jvs.2019.10.083. Epub 2019 Dec 31. PMID: 31901363.