Intraoperative myocardial ischemia in peripheral vascular surgery: general anesthesia vs combined sciatic and femoral nerve blocks

Yazigi, Alexandre; Madi-Gebara, Samia; Haddad, Fadia; Hayeck, Gemma; Tabet, Georges

doi:10.1016/j.jclinane.2004.11.006

Cited by 34 publications

(20 citation statements)

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“…[16] Given the increasing interest in peripheral nerve block, a large number of cases reported in several countries support the use of peripheral nerve block instead of GEA. [11,17,18] Although reports have described the effects of peripheral nerve block in patients undergoing major LEA, such as above- or below-knee amputation, no studies have investigated these effects in patients undergoing minor LEA, such as distal foot amputation. [16,19,20] …”

Section: Introductionmentioning

confidence: 99%

Comparison of the effects of remifentanil-based general anesthesia and popliteal nerve block on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation

et al. 2016

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Diabetic foot ulcer is the most common cause of diabetes-associated nontraumatic lower extremity amputation. Most patients who undergo lower extremity amputation for a diabetic foot have had diabetes for a long time and suffer from multiorgan disorder; thus, it can be a challenge to ensure sufficient anesthetic and analgesic effects while maintaining stable hemodynamics. Recently, peripheral nerve block has gained popularity owing to its attenuating effects of systemic concerns. This retrospective observational study aimed to compare the effects of remifentanil-based general anesthesia (GEA) and popliteal nerve block (PNB) on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation.A total of 59 consecutive patients with a diabetic foot who underwent distal foot amputation between January 2012 and May 2014 were retrospectively reviewed. Patients received remifentanil-based GEA (GEA group, n = 32) or PNB (PNB group, n = 27). The primary outcomes were to evaluate postoperative analgesic effects and perioperative hemodynamics. Also, postoperative pulmonary complications and 6-month mortality were assessed as secondary outcomes.Significant differences in pain scores using numeric rating scale were observed between the groups in a linear mixed model analysis (PGroup×Time = 0.044). Even after post hoc analysis with the Bonferroni correction, the numeric rating scale scores were significantly lower in the PNB group. Furthermore, patients in the PNB group required less pethidine during the first 6 hours after surgery (27 ± 28 vs 9 ± 18 mg; P = 0.013). The GEA group had a lower mean blood pressure (Bonferroni-corrected P < 0.01), despite receiving more ephedrine (P < 0.001). Significantly more patients in the GEA group suffered from postoperative pneumonia and required the management in intensive care unit (P = 0.030 and 0.038, respectively). However, the groups did not differ in terms of 6-month mortality.This study demonstrated that compared with remifentanil-based GEA, PNB might be a favorable option for diabetic patients undergoing distal foot amputation, despite the lack of significant mortality benefits, as PNB was associated with improved postoperative analgesia, hemodynamic stability, and a low incidence of pulmonary complications during the immediate postoperative period, especially in high-risk patients.

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Section: Introductionmentioning

confidence: 99%

Comparison of the effects of remifentanil-based general anesthesia and popliteal nerve block on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation

et al. 2016

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“…In 1992, Myerson et al [3] reported improved outcomes with anesthesia and found that about 70% of foot and ankle joint surgeries can be carried out with nerve block. It has been reported that peripheral nerve blocks reduce the cardiovascular side effects associated with regional or general anesthesia [4,5]. Among various nerve blocks, popliteal sciatic nerve block (PSNB) has the disadvantage of causing a minor effect on the saphenous nerve territory.…”

Section: Introductionmentioning

confidence: 99%

Popliteal sciatic nerve block versus spinal anesthesia in hallux valgus surgery

Jeon¹,

Park²,

Lee³

et al. 2013

Korean J Anesthesiol

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BackgroundWe compared clinical properties and patient satisfaction between spinal anesthesia and popliteal sciatic nerve block (PSNB) for hallux valgus surgery.MethodsForty patients undergoing hallux valgus surgery were divided into spinal group (spinal anesthesia with 2.5 ml of 0.5% bupivacaine [n = 20]) and PSNB group (PSNB with 30 ml of 0.75% ropivacaine mixed with 10 ml of normal saline solution using a nerve stimulator [n = 20]). The PSNB group used a patient-controlled-analgesia (PCA) pump for postoperative pain control. The quality and side effects were compared between the two groups. A questionnaire was used to evaluate patient satisfaction with the use of anesthetic techniques and postoperative pain control in the PSNB group. This study was assessed 3 days postoperatively by a blinded observer.ResultsProcedure time and time from anesthesia until start of sugery were significantly shorter in the spinal group than those in the PSNB group (P < 0.01). Anesthesia-related complications such as hypotension, bradycardia, shivering, nausea/vomitting, post-dural puncture headache (PDPH) and urinary retension were observed in 15%, 10%, 5%, 5%, 10%, and 20% of patients in the spinal group, respectively. PSNB was not associated with these complications. Patient satisfaction was slightly higher for PSNB than for spinal anesthesia. In the PSNB group, patient satisfaction with postoperative pain-control was 95% above ordinary satisfaction.ConclusionsDespite the long duration of the procedure, PSNB is relatively safe, provides an adequate level of anesthesia, effectively controls postoperative pain and reduces side effects. Therefore, PSNB could be a potential anesthetic technique for hallux valgus surgery.

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“…The possibility of performing loco-regional anesthesia, which is associated with a lower rate of complications compared with general anesthesia, may help surgeons start surgery as soon as possible. 43,44 Moreover, loco-regional anesthesia can provide a very prolonged postoperative analgesia. Intravenous broad-spectrum antibiotic therapy is immediately administered.…”

Section: S Aureus β-Hemolytic Streptococcus and Enterobacteriaceaementioning

confidence: 99%

Saving the Limb in Diabetic Patients With Ischemic Foot Lesions Complicated by Acute Infection

Clerici¹,

Faglia²

2014

The International Journal of Lower Extremity Wounds

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Ischemia and infection are the most important factors affecting the prognosis of foot ulcerations in diabetic patients. To improve the outcome of these patients, it is necessary to aggressively treat 2 important pathologies--namely, occlusive arterial disease affecting the tibial and femoral arteries and infection of the ischemic diabetic foot. Each of these 2 conditions may lead to major limb amputation, and the presence of both critical limb ischemia (CLI) and acute deep infection is a major risk factor for lower-extremity amputation. Thus, the management of diabetic foot ulcers requires specific therapeutic approaches that vary significantly depending on whether foot lesions are complicated by infection and/or ischemia. A multidisciplinary team approach is the key to successful treatment of a diabetic foot ulcer: ischemic diabetic foot ulcers complicated by acute deep infection pose serious treatment challenges because high levels of skill, organization, accuracy, and timing of intervention are required to maximize the chances of limb salvage: these complex issues are better managed by a multidisciplinary clinical group.

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Intraoperative myocardial ischemia in peripheral vascular surgery: general anesthesia vs combined sciatic and femoral nerve blocks

Cited by 34 publications

References 20 publications

Comparison of the effects of remifentanil-based general anesthesia and popliteal nerve block on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation

Comparison of the effects of remifentanil-based general anesthesia and popliteal nerve block on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation

Popliteal sciatic nerve block versus spinal anesthesia in hallux valgus surgery

Saving the Limb in Diabetic Patients With Ischemic Foot Lesions Complicated by Acute Infection

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