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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: A retrospective observational study

 Na Young Kim  ;  Ki-Young Lee  ;  Sun Joon Bai  ;  Jung Hwa Hong  ;  Jinwoo Lee  ;  Jong Min Park  ;  Shin Hyung Kim 
 MEDICINE, Vol.95(29) : 4302, 2016 
Journal Title
Issue Date
Aged ; Amputation* ; Anesthesia, General* ; Diabetic Foot/surgery* ; Female ; Hemodynamics/drug effects* ; Humans ; Male ; Middle Aged ; Pain Measurement ; Pain, Postoperative/diagnosis* ; Peripheral Nerves/drug effects* ; Piperidines* ; Retrospective Studies
diabetic foot ; distal foot amputation ; hemodynamic stability ; popliteal nerve block ; postoperative complication ; postoperative pain ; remifentanil-based general anesthesia
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.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Na Young(김나영) ORCID logo https://orcid.org/0000-0003-3685-2005
Kim, Shin Hyung(김신형) ORCID logo https://orcid.org/0000-0003-4058-7697
Bai, Sun Joon(배선준) ORCID logo https://orcid.org/0000-0001-5027-3232
Lee, Ki Young(이기영) ORCID logo https://orcid.org/0000-0003-4893-3195
Lee, Jin Woo(이진우) ORCID logo https://orcid.org/0000-0002-0293-9017
Hong, Jung Hwa(홍정화)
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