A not so sweet scenario: impact of perioperative glucose control on regional anesthetic techniques for orthopedic surgery. Issue 2 (18th April 2022)

• Record Type: Journal Article
• Authors: Nowrouz, Maliha; Buxhoeveden, Michael
• Is Part Of: Current opinion in anaesthesiology. Volume 35:Issue 2(2022)
• Page Start: 255
• Page End: 258
• Publication Date: 2022-04-18
• Subjects: hyperglycemia -- infection -- orthopedic surgery -- peripheral nerve catheters -- regional anesthesia; Anesthesiology -- Periodicals; Anesthesiology -- Indexes; Anesthesiology -- Periodicals; Review Literature -- Indexes; Review Literature -- Periodicals; Anesthesiology; Periodicals; 617.9605
• DOI: 10.1097/ACO.0000000000001106
• Languages: English
• ISSNs: 0952-7907

Abstract

Abstract : Purpose of review: Diabetes and hyperglycemia are well established risk factors for complications associated with common orthopedic surgeries. In some practice settings, these conditions are also viewed as contraindications to regional nerve catheters. In this article, we aim to present our approach to offering the benefits of this modality in a safe manner for patients with diabetes and even some with preexisting, localized infections. Recent findings: Evidence suggests that reduction in opioids and avoidance of general anesthesia can be particularly beneficial for patients with diabetes and high blood sugar, who often suffer from comorbid conditions such as obesity and obstructive sleep apnea. On our high volume, high acuity acute pain service, we take a selective approach to nerve catheter placement in this population and even some who already have localized infections. In our experience, with careful monitoring and risk mitigation strategies these patients have improved pain control and an exceedingly low rate of complications associated with nerve catheter use. Summary: Based on our experience and reading of the literature, we advocate for a liberalized approach to use of continuous regional anesthesia for diabetic patients having for orthopedic surgery. A set of consensus guidelines tailored to institutions' resources and monitoring capabilities can be a useful tool for standardizing care. It may also increase access to the clinical benefits of this modality in a population particularly vulnerable to opioid related adverse effects.