Breaking with tradition: perioperative care without fasting or medication changes for diabetic foot surgery

This study explores a new approach for managing high-risk diabetic patients undergoing diabetic-foot surgery, where traditional practices like preoperative fasting and medication changes are bypassed. We aimed to assess the safety and complications of using a popliteal-sciatic nerve block in this unique scenario, while also evaluating the impact on blood glucose levels and surgeon satisfaction.

The study included high-risk patients classified in the American Society of Anesthesiologists (ASA) III group, where general anesthesia was avoided due to elevated risk factors. Crucially, patients maintained their regular daily routines, with no changes to their medication regimen and they were not required to fast. After enjoying a light breakfast, patients were prepped with standard monitoring and an ultrasound-guided popliteal-sciatic block was performed with the patient in the prone position. Data on patient outcomes and surgeon satisfaction were recorded and analyzed.

A total of 320 blocks were performed as some of the 142 patients required multiple surgical interventions. All of these patients successfully underwent surgery without the need for general anesthesia. Surgeon satisfaction was remarkable high, with a mean score of 4.6 ± 0.8 on a 5-point Likert scale (1 = very poor, 5 = very good), and only 1 patient (0.3%) developed a postoperative hematoma. Patients who did not require sedatives (midazolam) and additional analgesics (fentanyl) had higher surgeon satisfaction scores.

Our findings reveal that for high-risk patients with chronic conditions, a popliteal-sciatic nerve block offers a safe and effective alternative for diabetic foot surgery, eliminating the need for fasting or medication adjustments. This method not only ensures patient safety but also potentially setting a new standard in perioperative care.