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

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

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 (PGroupxTime=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 6hours 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.

Original languageEnglish
Article numbere4302
JournalMedicine (United States)
Volume95
Issue number29
DOIs
Publication statusPublished - 2016 Jul 26

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Nerve Block
Postoperative Pain
Amputation
General Anesthesia
Observational Studies
Foot
Retrospective Studies
Hemodynamics
Diabetic Foot
Analgesics
Mortality
Lower Extremity
Ephedrine
Lung
Meperidine
remifentanil
Peripheral Nerves
Postoperative Period
Analgesia
Intensive Care Units

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

@article{7eac0d9f305a48d8bad9d3db41452785,
title = "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",
abstract = "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 (PGroupxTime=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 6hours 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.",
author = "Kim, {Na Young} and Lee, {Ki Young} and Bai, {Sun Joon} and Hong, {Jung Hwa} and jinwoo lee and Park, {Jong Min} and Kim, {Shin Hyung}",
year = "2016",
month = "7",
day = "26",
doi = "10.1097/MD.0000000000004302",
language = "English",
volume = "95",
journal = "Medicine (United States)",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
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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. / Kim, Na Young; Lee, Ki Young; Bai, Sun Joon; Hong, Jung Hwa; lee, jinwoo; Park, Jong Min; Kim, Shin Hyung.

In: Medicine (United States), Vol. 95, No. 29, e4302, 26.07.2016.

Research output: Contribution to journalReview article

TY - JOUR

T1 - 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

T2 - A retrospective observational study

AU - Kim, Na Young

AU - Lee, Ki Young

AU - Bai, Sun Joon

AU - Hong, Jung Hwa

AU - lee, jinwoo

AU - Park, Jong Min

AU - Kim, Shin Hyung

PY - 2016/7/26

Y1 - 2016/7/26

N2 - 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 (PGroupxTime=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 6hours 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.

AB - 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 (PGroupxTime=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 6hours 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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U2 - 10.1097/MD.0000000000004302

DO - 10.1097/MD.0000000000004302

M3 - Review article

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JO - Medicine (United States)

JF - Medicine (United States)

SN - 0025-7974

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