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Effectiveness of Peripheral Nerve Block in Terms of Search for a Standardized Treatment Protocol in Diabetic Foot Patients Using Anticoagulants: A Double-Center Study

Derya Ozkan Department of Anaesthesiology and Reanimation, Diskapi Research and Training Hospital, University of Health Sciences, Ankara, Turkey.

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M. Tugba Arslan Department of Anaesthesiology and Reanimation, Diskapi Research and Training Hospital, University of Health Sciences, Ankara, Turkey.

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Mehmet Burak Eskin Department of Anaesthesiology and Reanimation, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey.

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Fatma Ozkan Sipahioglu Department of Anaesthesiology and Reanimation, Diskapi Research and Training Hospital, University of Health Sciences, Ankara, Turkey.

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Yasemin Ermis Department of Anaesthesiology and Reanimation, Diskapi Research and Training Hospital, University of Health Sciences, Ankara, Turkey.

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Gokhan Ozkan Department of Anaesthesiology and Reanimation, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey.

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Ibrahim Yilmaz Department of General Surgery, Diskapi Research and Training Hospital, University of Health Sciences, Ankara, Turkey.

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Burak Nalbant Department of Anaesthesiology and Reanimation, Diskapi Research and Training Hospital, University of Health Sciences, Ankara, Turkey.

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Sinan Yuksel Department of Orthopedics and Traumatology, Diskapi Research and Training Hospital, University of Health Sciences, Ankara, Turkey.

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Kerim Bora Yilmaz Department of General Surgery, Diabetic Foot Clinic, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey.

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Background: Lower-extremity amputation for a diabetic foot is mainly performed under general or central neuraxial anesthesia. Ultrasound-guided peripheral nerve block (PNB) can be a good alternative, especially for patients who require continuous anticoagulation treatment and patients with additional comorbidities. We evaluated bleeding due to PNB application in patients with diabetic foot receiving antiplatelet or anticoagulant therapy. Perioperative morbidity and mortality and the need for intensive care hospitalization were analyzed.

Methods: This study included 105 patients with diabetic foot or debridement who underwent distal foot amputation or debridement between February and October 2020. Popliteal nerve block (17 mL of 5% bupivacaine and 3 mL of saline) and saphenous nerve block (5 mL of 2% lidocaine) were applied to the patients. Postoperative pain scores (at 4, 8, 12, and 24 hours) and complications due to PNB were evaluated. Intensive care admission and 1-month mortality were recorded.

Results: The most common diseases accompanying diabetes were hypertension and peripheral artery disease. No complications due to PNB were observed. Mean ± SD postoperative first analgesic need was determined to be 14.1 ± 4.1 hours. Except for one patient, this group was followed up without the need for postoperative intensive care. In 16 patients, bleeding occurred as leakage from the surgical area, and it was stopped with repeated pressure dressing. Mean ± SD patient satisfaction score was 8.36 ± 1.59. Perioperative mortality was not observed.

Conclusions: Ultrasound-guided PNB can be an effective and safe anesthetic technique for diabetic patients undergoing distal foot amputation, especially those receiving antiplatelet or anticoagulant therapy and considered high risk.

Corresponding author: M. Tugba Arslan, MD, Department of Anaesthesiology and Reanimation, Diskapi Research and Training Hospital, University of Health Sciences, Altındağ, Ankara 06110, Turkey. (E-mail: tuba.kokulu@gmail.com)
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