The effect of single injection and continuous infusion of popliteal nerve block on pain and hemodynamics in diabetic foot operations

Background: In patients undergoing diabetic foot surgery, complications due to neuraxial or general anesthesia may occur due to uncontrolled diabetes. Regional anesthesia methods can be preferred to prevent these. In this study, the results of continuous infusion and single injection and popliteal nerve block application in terms of hemodynamic effects and pain were compared in patients undergoing surgical intervention for diabetic foot. Materials and Methods: Following the approval of the ethics committee, 63 cases in the ASA II-IV risk group who would undergo popliteal nerve block as an anesthetic method for diabetic foot surgery were randomized into two groups. Group 1 (n: 31) patients were given 30 mL of local anesthetic around the popliteal nerve with ultrasonography and nerve stimulator. In the patients in group 2, the catheter was placed 4-5 cm beyond the tip of the needle in addition. An elastomeric pump was prepared for 0.25% bupivacaine infusion at a rate of 2 mL / hr. Before and after the block, hemodynamic parameters were recorded. Block start and end times were recorded. Postoperative pain scores, hemodynamic parameters, time to analgesic requirement, patient satisfaction and discharge time were followed. Result: Pain scores were high after the postoperative 12th hour in Group 1 and after the 60th hour in Group 2 (P = 0.006, P <0.01, respectively). In Group 2, it was lower than Group 1 until the postoperative 60th hour, and it was significantly higher afterwards. Block time was 631.56 ± 218.72 minutes in Group 1 and 733.26 ± 435.83 minutes in Group 2. The time until the first analgesic need is on average 804.64 ± 1020.8 minutes in Group 1 and 2012.78 ± 1424 minutes in Group 2 and is statistically similar (P = 0.072). Systolic, diastolic, mean arterial blood pressure and heart rate measured before and after successful block were similar between groups (P> 0.5). Conclusion: It has been revealed that popliteal nerve block provides a longer painless period and stable hemodynamics with continuous infusion method. It was observed that both methods had similar hemodynamic data and low pain scores. Although the continuous infusion method appears to provide better analgesia, the cost of the procedure, technical difficulties and adverse effects on patient comfort should also be considered. Keywords: Popliteal Nerve Block, Diabetic Foot, Pain, Single Injection, Continuous Infusion