Diabetes mellitus is a common endocrine disease with India leading the world in prevalence of the disease. Patients with Diabetes Mellitus present with foot surgeries with proven neuropathies. A complete search of the Pubmed, Cochrane and Scopus databases was done for the articles on the safety of the local anaesthetic drugs inside the nerve with established neuropathy. Relevant articles with their methodologies were analysed. Patients with long term diabetes mellitus have multiple other comorbidities; administration of either General or neuraxial technique of anaesthesia may not be favoured. Autonomic imbalance and hemodynamic instability in central neuraxial blockade happen in such cases. The problem of airway control, presence of organ dysfunction may make general anaesthesia an unfriendly choice. Hence, blocking the sciatic nerve in the popliteal site is very popular in these patients. The advent of ultrasound and a better knowledge of extra neural injections is advantageous in these patients with known neuropathy. It has also made the action to be more definite with decreased dosage of drugs.  The concept of double crush phenomenon of additional damage caused by local anaesthetics is not clinically very significant. Local anaesthetics as plain solutions seem to be better than mixing with additives with unknown toxic potential. Given the pros and cons, the targeted ultrasound guided nerve blocks seem to be advantageous with negligible side effects.

REFERENCE

1.       Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Ann NY Acad Sci. 2018;1411(1):153-65. doi: 10.1111/nyas.13569, PMID 29377202.

2.       Hogan QH. Pathophysiology of peripheral nerve injury during regional anesthesia. Reg Anesth Pain Med. 2008;33(5):435-41. doi: 10.1016/j.rapm.2008.03.002, PMID 18774512.

3.       Jones MR, Urits I, Wolf J, Corrigan D, Colburn L, Peterson E, Williamson A, Viswanath O. Drug-induced peripheral neuropathy: A narrative review. Curr Clin Pharmacol. 2020;15(1):38-48. doi: 10.2174/1574884714666190121154813, PMID 30666914.

4.       Pendsey SP. Understanding diabetic foot. Int J Diabetes Dev Ctries. 2010;30(2):75-9. doi: 10.4103/0973-3930.62596, PMID 20535310.

5.       Clayton W, Elasy TA. A Review of the Pathophysiology, Classification, and Treatment of Foot Ulcers in Diabetic Patients. Clin Diabetes. 2009;27(2):52-8. doi: 10.2337/diaclin.27.2.52.

6.       Shwetha K, Dakshayani KR. Bilateral high division of sciatic nerve. Int J Res Med Sci. 2014;2(4):1785-7. doi: 10.5455/2320-6012.ijrms201411114.

7.       Côté AV, Vachon CA, Horlocker TT, Bacon DR. From victor Pauchet to Gaston Labat: the transformation of regional anesthesia from a surgeon’s practice to the physician anesthesiologist. Anesth Analg. 2003;96(4):1193-200. doi: 10.1213/01.ane.0000049823.67729.1d, PMID 12651684.

8.       Beck GP. Anterior approach to sciatic nerve block. Anesthesiology. 1963;24:222-4. doi: 10.1097/00000542-196303000-00011, PMID 13970060.

9.       Raj PP, Parks RI, Watson TD, Jenkins MT. A new single-position supine approach to sciatic-femoral nerve block. Anesth Analg. 1975;54(4):489-93. doi: 10.1213/00000539-197507000-00020, PMID 1170786.

10.     Van Geffen GJ, van den Broek E, Braak GJ, Giele JL, Gielen MJ, Scheffer GJ. A prospective randomised controlled trial of ultrasound guided versus nerve stimulation guided distal sciatic nerve block at the popliteal fossa. Anaesthesiol Intensive Care. 2009;37(1):32-7. doi: 10.1177/0310057X0903700115, PMID 19157343.

11.     Canales MB, Matthew Reiner HH, Mark Razzante DJE. The Popliteal Nerve Block in Foot and Ankle Surgery: an Efficient and Anatomical Technique. J Anesth Clin Res;06(8). doi: 10.4172/2155-6148.1000553.

12.     Li J, Halaszynski T. Neuraxial and peripheral nerve blocks in patients taking anticoagulant or thromboprophylactic drugs: challenges and solutions. Local Reg Anesth. 2015;8:21-32. doi: 10.2147/LRA.S55306, PMID 26347411.

13.     Moningi S, Nikhar S, Ramachandran G. Autonomic disturbances in diabetes: assessment and anaesthetic implications. Indian J Anaesth. 2018;62(8):575-83. doi: 10.4103/ija.IJA_224_18, PMID 30166651.

14.     Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973 Aug 18;2(7825):359-62. doi: 10.1016/s0140-6736(73)93196-6, PMID 4124532.

15.     Lirk P, Verhamme C, Boeckh R, Stevens MF, ten Hoope W, Gerner P, Blumenthal S, de Girolami U, van Schaik IN, Hollmann MW, Picardi S. Effects of early and late diabetic neuropathy on sciatic nerve block duration and neurotoxicity in Zucker diabetic fatty rats. Br J Anaesth. 2015;114(2):319-26. doi: 10.1093/bja/aeu270. PMID 25145353.

16.     Cuvillon P, Reubrecht V, Zoric L, Lemoine L, Belin M, Ducombs O, Birenbaum A, Riou B, Langeron O. Comparison of subgluteal sciatic nerve block duration in type 2 diabetic and non-diabetic patients. Br J Anaesth. 2013 May;110(5):823-30. doi: 10.1093/bja/aes496, PMID 23348203.

17.     Baeriswyl M, Taffé P, Kirkham KR, Bathory I, Rancati V, Crevoisier X, Cherix S, Albrecht E. Comparison of peripheral nerve blockade characteristics between non-diabetic patients and patients suffering from diabetic neuropathy: a prospective cohort study. Anaesthesia. 2018;73(9):1110-7. doi: 10.1111/anae.14347, PMID 29858510.

18.     Younger DS, Rosoklija G, Hays AP, Trojaborg W, Latov N. Diabetic peripheral neuropathy: a clinicopathologic and immunohistochemical analysis of sural nerve biopsies. Muscle Nerve. 1996;19(6):722-7. doi: 10.1002/(SICI)1097-4598(199606)19:6<722::AID-MUS6>3.0.CO;2-C, PMID 8609922.

19.     Lirk P, Brummett CM. Regional anaesthesia, diabetic neuropathy, and dexmedetomidine: a neurotoxic combination? Br J Anaesth. 2019;122(1):16-8. doi: 10.1016/j.bja.2018.09.017, PMID 30579401.