Ultrasound-Guided Ankle Block in Diabetic Foot Surgery: Association Between Glycemic Control and Block Onset

Area of Science:

• Anesthesiology
• Diabetology
• Podiatric Surgery

Background:

• Patients undergoing distal diabetic foot surgery often present with diabetic peripheral neuropathy and significant systemic health issues.
• Diabetic peripheral neuropathy impacts surgical outcomes and anesthetic considerations.

Purpose of the Study:

• To investigate the relationship between preoperative glycated hemoglobin (HbA1c) levels and the onset time of ultrasound-guided ankle blocks.
• To assess if glycemic control influences the efficacy of regional anesthesia in diabetic patients.

Main Methods:

• A prospective observational study included adult patients with diabetic peripheral neuropathy undergoing foot surgery.
• Participants were categorized based on HbA1c levels (<8.0% or ≥8.0%).
• Primary outcome was sensory block onset time, with secondary evaluation of postoperative pain, opioid use, and patient satisfaction.

Main Results:

• A shorter sensory block onset was observed in patients with HbA1c ≥8.0% compared to those with HbA1c <8.0% (4.9 vs. 7.4 minutes).
• Motor block onset was also significantly shorter in the higher HbA1c group.
• Postoperative pain, opioid consumption, and patient satisfaction levels were similar between the groups.

Conclusions:

• Elevated preoperative HbA1c levels are associated with a modestly faster onset of ultrasound-guided ankle blocks in patients with diabetic peripheral neuropathy.
• The clinical relevance of this accelerated onset and its impact on block duration warrant further investigation.