ABSTRACT:

Background And Objectives: The prevalence of diabetes mellitus and chronic kidney disease continue to rise in developing countries.The impact of diabetes mellitus on practice of peripheral nerve block anesthesia, however ,has not been fully elucidated.The objective of the present study is to assess the efficacy of ultrasound guided supraclavicular block in diabetic versus non-diabetic CKD patients undergoing arteriovenous fistula surgery.

METHODS: Sixty CKD patients undergoing AV fistula surgery under Ultrasound guided supraclavicular brachial plexus block were prospectively studied.Patients were randomly categorized into two groups as diabetic(group D,n=30) and non-diabetic group(group ND,n=30).A standardized local anesthetic mixture solution containing 10ml of 0.5% bupivacaine and 10ml of 2%lignocaine with adrenaline was used in both the groups.The primary outcome was studied as combined score of onset of sensory and motor blockade and the secondary outcome as duration and regression of blockade.Analgesic effects during surgery,visualanalog scale pain scores,skinsensation,muscle strength and post-op patient satisfaction indices were evaluated.

RESULTS: In our study we found that there was delayed onset of sensory and motor blockade in group D and prolonged duration and regression of blockade when compared to group ND patients.

CONCLUSION: From our study we found that the delayed onset of sensory and motor blockade and prolonged duration and regression of blockade in diabetic CKD patients was probably due to(i) higher sensitivity of nerve fibers to local anesthetics in diabetic patients, (ii) impaired nerve conduction, and/or (iii)preexisting neuropathy with accompanying decreased sensation.