Big Toe Amputation With Diabetic Peripheral Neuropathy

Abstract

Abstract Diabetic peripheral neuropathy is the most common form of neuropathy in developed countries. Surgical procedures in people with diabetes are not uncommon, and the need for regional anesthesia in these patients continues to rise. Regional anesthesia provides satisfactory surgical conditions and good postoperative pain relief with little systemic effect. Diabetic nerves are more sensitive to local anesthetic toxicity. Due to that sensitivity, nerve blocks in these patients have higher success rates, shorter onset times, and a longer duration; in addition, patients generally require less postoperative analgesia. However, the incidence of neurologic injury in this patient cohort is higher than in patients without neuropathy. When performing nerve blocks in patients with diabetic peripheral neuropathy, providers must consider the risk-to-benefit ratio and avoid localizing the nerve-by-nerve stimulation alone. Ultrasound guidance can improve the accuracy of needle placement and help reduce the volume of local anesthetic used. Because local anesthetics are generally neurotoxic, lower volumes and concentrations are recommended.