Effect Of Different Concentration Of Local Anesthetics On Lumbar Plexus Block In Patients With Increased Risk Factors Of Diabetic Polyneuropathy

Objective:The incidence of diabetes worldwide has risen sharply since the last century.There are about 328 million diabetics in the world today and are expected to reach 592 million by 2035.Patients with diabetes are more likely to undergo surgery and anesthesia than non-diabetic patients.Neuropathy is a common and costly complication of both type 1 and type 2 diabetes.In fact,the prevalence of neuropathy in patients with diabetes is approximately 30%.With the rapid development of enhanced recovery after surgery,nerve block is increasingly recommended as a method of multi-mode analgesia after operation.Clinical and animal studies have shown that the duration of nerve block in diabetic patients is prolonged,and to achieve the same analgesic effect,and the concentration of local anesthetic needed in diabetic neuropathy rats is reduced.while studies have found that the same concentration of local anesthetics may produce more neuroedema and axonal spectrum abnormalities in diabetic rats.Therefore,the purpose of this experiment is to explore that when the risk factors of diabetic polyneuropathy increase patients with nerve block analgesia,a lower concentration of local anesthetic can meet the needs of postoperative analgesia,while reducing the possible associated nerve damage.Methods: selected from april 2019 to january 2020 ASA grade ⅠtoⅢ.80 patients undergoing total hip arthroplastyt replacement under selective intraspinal anesthesia were selected.among them,60 patients with increased risk factors fordiabetic polyneuropathy were randomly divided into three groups,20 patients in each group,labeled T1 group,T2 group,T3 group and 20 nondiabetic patients in control group,recorded as S group.all patients were treated with lumbar plexus nerve block by the same anesthesiologist,and then with spinal anesthesia.The concentration of ropivacaine in nerve block in group T1,group T2,group T3 and group S were0.5%,0.375%,0.25% and 0.5%,respectively,and the volume of local anesthetic is 25 ml in All four groups.The main observation index:(1)The effective analgesic time of lumbar plexus block,defined as the successful time of lumbar plexus block to the first oral Oxycodone and Acetaminophen Tablets in patients;(2)The duration of Sensory and motor of lumbar plexus block.Secondary observation index:(1)The occurrence of intraoperative hypotension and bradycardia;(2)Numerical Rating Scale(NRS)for the first time out of bed;(3)Resting NRS pain scores for 4 hours,6 hours,8 hours,12 hours and 24 hours after operation;(4)The consumption of Oxycodone and Acetaminophen Tablets;(5)Patient satisfaction with postoperative analgesia;(6)Recording of adverse symptoms associated with nerve block such as dyskinesia and abnormal limb sensation.Results:1.There was no significant difference in the general data of the four groups(P >0.05).2.The results of the analysis of the application time of the first oral Oxycodone and Acetaminophen Tablets in the four groups showed that the T1 group was larger than the S group,the T2 group and the T3 group,the difference was statistically significant(P <0.05),and there was no significant difference between the S group,the T2 group and the T3 group.3.The incidence of intraoperative hypotension and bradycardia were compared,the T1 group was larger than S group,T2 group and T3 group,the difference was statistically significant(P <0.05)4.The duration of Sensory and motor of lumbar plexus block.5.Postoperative sensory and motor block duration analysis showed :(1)The duration of motor block: there was significant difference in the motor block between the four groups(p<0.05),T1 group motor block duration was the longest,the difference was statistically significant(p<0.05);T3 group motor block duration was the shortest.(p<0.05).(2)The duration of sensory block: there was significant difference in the duration of sensory block between the four groups(p<0.05)T1 group had the longest duration of sensory block and the difference was statistically significant(0.05).6.The results of generalized linear analysis between NRS groups at each time point after operation showed that the difference of 8 h(NRS)was statistically significant(P <0.05),and the difference of 4 h,6 h,12 h,24 h(NRS)was not statistically significant(P >0.05).The two comparison results after the event were as follows: group S 8 h(NRS)was larger than group T1,group T2,group T3.7.The analysis of postoperative analgesic application showed that the dosage of Oxycodone and Acetaminophen Tablets in S group was greater than that in T1 group,the difference was statistically significant(P <0.05),and there was no significant difference in analgesic application between T1 group,T2 group and T3 group(P >0.05).8.No adverse reactions associated with nerve block were observed in four groups.Conclusion:In patients with high-risk diabetic polyneuropathy,the use of lumbar plexus blocking pain after the use of 0.25% ropivacaine can meet the needs of postoperative multimodal analgesia,while reducing the possible nerve damage.