Comparison of Postoperative Pain and Analgesia Requirement among Diabetic and Nondiabetic Patients undergoing Lower Limb Fracture Surgery – A Prospective Observational Study

Abstract

Background: Diabetic patients usually experience neuropathic pain and have a decreased response to opioids. Fractures are acute conditions and as such, they are very painful. No data is available related to fracture and postoperative pain in diabetics. Aim: This study was conducted to evaluate postoperative pain and analgesics requirement among diabetic and nondiabetic patients undergoing lower limb fracture surgery and the effect of glycosylated hemoglobin (HbA1c) on the postoperative pain. Setting and Design: This was a prospective observational study, conducted on 80 patients comprising of nondiabetic and diabetic, scheduled for elective lower limb fracture surgery under spinal anesthesia. Materials and Methods: HbA1c was done in all the patients who were included in the study. Postoperative Visual Analog Scale (VAS) and analgesic consumption were assessed by an anesthesiologist blinded to the diabetic or nondiabetic status of the patients. VAS was assessed every 2 nd hourly, for 24 h and rescue analgesia was given if the VAS was ≥4 and record was maintained. Sedation scores and adverse effects were also recorded postoperatively. Statistical Analysis: The Chi-square test was used for the analysis of categorical variables and Student's t -test was used for continuous variables. Results: Diabetic group of patients had a significantly high VAS score with P ≤ 0.05. Rescue analgesics requirement was significantly different in two groups with diabetic patients requiring more supplementation of analgesia with a P = 0.025. The overall patient satisfaction was lesser in diabetic group ( P = 0.004). There was statistically significant correlation between glycosylated hemoglobin and VAS at 2 nd , 16 th , 18 th , 20 th , 22 nd , and 24 th h. Conclusion: Postoperative pain and analgesic requirement was significantly higher in diabetic patients with lower limb fracture. Glycosylated hemoglobin had good correlation with higher VAS.

Postoperative opioid prescribing patients with diabetes: Opportunities for personalized pain management

“…Future studies should evaluate if years of exposure (i.e., time from diagnosis) better predicts the increased odds of POU than specific diagnosis (DMI vs DMII). Similarly, the degree of hyperglycemia over time may partially mediate this effect, and the interaction of degree of elevation in hemoglobin A1C and time over which the patients has been exposed to that hyperglycemia (time since diagnosis) may ultimately prove better at predicting individual risk of POU than the specific diagnosis [ 35 ]. These results suggest that in the same way we appreciate diabetes as a systemic condition impairing the vascular system, the peripheral nervous system, the kidneys and retinas, we need to appreciate an effect on pro-nociceptive components of the sensory nervous system.…”

“…Prior research reported diabetes as a risk factor for POU [ 10 , 36 – 40 ]. However, most studies did not differentiate outcomes between DMI and DMII patients, and our findings further highlight disparities among diabetic subgroups warranting further investigation.…”