Diabetic Peripheral Neuropathy Increases Electrical Stimulation Threshold of Sciatic Nerve: A Prospective Parallel Cohort Study

Overview

Journal Diabetes Metab Syndr Obes

Publisher Dove Medical Press

Specialty Endocrinology

Date 2020 Nov 26

PMID 33239897

Citations 5

Authors

Guang Ying Zhang

Yi Feng Chen

Wei Xin Dai

Dan Zhang

Yi Huang

Wen Zheng He

Cheng Xin Lin

Affiliations

Soon will be listed here.

Abstract

Purpose: To investigate the impact of diabetic peripheral neuropathy and its severity on the threshold of sciatic nerve electrical stimulation in diabetic patients.

Patients And Methods: The case-control study included 60 patients that were divided into non-diabetic patients (control group, n = 26) and diabetic patients (diabetes group, n = 34). All the patients who were scheduled for lower leg, foot, and ankle surgery received a popliteal sciatic nerve block. We recorded the minimum current required to produce motor activity of the sciatic nerve during ultrasound-guided popliteal sciatic nerve block.

Results: Among the 60 patients, the sciatic nerve innervated muscle contractile response was successfully elicited in 57 patients (dorsiflexion of foot, plantar flexion, foot valgus or adduction, toe flexion, etc.) under electric stimulation. We failed to elicit the motor response in three patients with diabetic peripheral neuropathy, even when the stimulation current was 3 mA. The average electrical stimulation threshold (1.0 ± 0.7 mA) in the diabetes group was significantly higher than that of the control group (0.4 ± 0.1 mA). Diabetic patients with peripheral neuropathy had a higher electrical stimulation threshold (1.2 ± 0.7 mA) than patients without peripheral neuropathy (0.4 ± 0.1 mA). Furthermore, the electrical stimulation threshold of the sciatic nerve in diabetic patients had a linear dependence on the Toronto Clinical Scoring System (TCSS) peripheral neuropathy score (electrical stimulation threshold [in mA] = 0.125 TCSS score) ( < 0.001).

Conclusion: The threshold of electrical stimulation to elicit a motor response of the sciatic nerve was increased in diabetic patients, and the threshold of electrical stimulation of the sciatic nerve increased with the severity of diabetic nerve dysfunction.

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References

Szerb J, Persaud D . Long current impulses may be required for nerve stimulation in patients with ischemic pain. Can J Anaesth. 2005; 52(9):963-6. DOI: 10.1007/BF03022059. View

De Andres J, Alonso-Inigo J, Sala-Blanch X, Reina M . Nerve stimulation in regional anesthesia: theory and practice. Best Pract Res Clin Anaesthesiol. 2005; 19(2):153-74. DOI: 10.1016/j.bpa.2004.11.002. View

Ogawa K, Sasaki H, Yamasaki H, Okamoto K, Matsuno S, Shono T . Peripheral nerve functions may deteriorate parallel to the progression of microangiopathy in diabetic patients. Nutr Metab Cardiovasc Dis. 2006; 16(5):313-21. DOI: 10.1016/j.numecd.2005.06.003. View

Freeman R . Not all neuropathy in diabetes is of diabetic etiology: differential diagnosis of diabetic neuropathy. Curr Diab Rep. 2009; 9(6):423-31. DOI: 10.1007/s11892-009-0069-7. View

Pop-Busui R, Boulton A, Feldman E, Bril V, Freeman R, Malik R . Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2016; 40(1):136-154. PMC: 6977405. DOI: 10.2337/dc16-2042. View

Bigeleisen P, Moayeri N, Groen G . Extraneural versus intraneural stimulation thresholds during ultrasound-guided supraclavicular block. Anesthesiology. 2009; 110(6):1235-43. DOI: 10.1097/ALN.0b013e3181a59891. View

Heschl S, Hallmann B, Zilke T, Gemes G, Schoerghuber M, Auer-Grumbach M . Diabetic neuropathy increases stimulation threshold during popliteal sciatic nerve block. Br J Anaesth. 2016; 116(4):538-45. PMC: 4797685. DOI: 10.1093/bja/aew027. View

Li L, Chen J, Wang J, Cai D . Prevalence and risk factors of diabetic peripheral neuropathy in Type 2 diabetes mellitus patients with overweight/obese in Guangdong province, China. Prim Care Diabetes. 2014; 9(3):191-5. DOI: 10.1016/j.pcd.2014.07.006. View

Brull R, Wijayatilake D, Perlas A, Chan V, Abbas S, Liguori G . Practice patterns related to block selection, nerve localization and risk disclosure: a survey of the American Society of Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med. 2008; 33(5):395-403. DOI: 10.1016/j.rapm.2008.02.007. View

10.

Chan V, Nova H, Abbas S, McCartney C, Perlas A, Xu D . Ultrasound examination and localization of the sciatic nerve: a volunteer study. Anesthesiology. 2006; 104(2):309-14, discussion 5A. DOI: 10.1097/00000542-200602000-00017. View

11.

Iqbal Z, Azmi S, Yadav R, Ferdousi M, Kumar M, Cuthbertson D . Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy. Clin Ther. 2018; 40(6):828-849. DOI: 10.1016/j.clinthera.2018.04.001. View

12.

Yang Q, Zhang Y, Zeng Q, Yang C, Shi J, Zhang C . Correlation Between Diabetic Peripheral Neuropathy and Sarcopenia in Patients with Type 2 Diabetes Mellitus and Diabetic Foot Disease: A Cross-Sectional Study. Diabetes Metab Syndr Obes. 2020; 13:377-386. PMC: 7025667. DOI: 10.2147/DMSO.S237362. View

13.

Lok C, Kirk P . Problems performing a sciatic nerve block in an amputee. Anaesthesia. 2003; 58(3):289-90. DOI: 10.1046/j.1365-2044.2003.306014.x. View

14.

Bril V, Perkins B . Validation of the Toronto Clinical Scoring System for diabetic polyneuropathy. Diabetes Care. 2002; 25(11):2048-52. DOI: 10.2337/diacare.25.11.2048. View

15.

Cho N, Shaw J, Karuranga S, Huang Y, da Rocha Fernandes J, Ohlrogge A . IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018; 138:271-281. DOI: 10.1016/j.diabres.2018.02.023. View

16.

Minville V, Zetlaoui P, Fessenmeyer C, Benhamou D . Ultrasound guidance for difficult lateral popliteal catheter insertion in a patient with peripheral vascular disease. Reg Anesth Pain Med. 2004; 29(4):368-70. DOI: 10.1016/j.rapm.2004.04.005. View

17.

Dhatariya K, Levy N, Kilvert A, Watson B, Cousins D, Flanagan D . NHS Diabetes guideline for the perioperative management of the adult patient with diabetes. Diabet Med. 2012; 29(4):420-33. DOI: 10.1111/j.1464-5491.2012.03582.x. View

18.

Roman-Pintos L, Villegas-Rivera G, Rodriguez-Carrizalez A, Miranda-Diaz A, Cardona-Munoz E . Diabetic Polyneuropathy in Type 2 Diabetes Mellitus: Inflammation, Oxidative Stress, and Mitochondrial Function. J Diabetes Res. 2017; 2016:3425617. PMC: 5183791. DOI: 10.1155/2016/3425617. View

19.

Alleman C, Westerhout K, Hensen M, Chambers C, Stoker M, Long S . Humanistic and economic burden of painful diabetic peripheral neuropathy in Europe: A review of the literature. Diabetes Res Clin Pract. 2015; 109(2):215-25. DOI: 10.1016/j.diabres.2015.04.031. View

20.

Pan Q, Li Q, Deng W, Zhao D, Qi L, Huang W . Prevalence of and Risk Factors for Peripheral Neuropathy in Chinese Patients With Diabetes: A Multicenter Cross-Sectional Study. Front Endocrinol (Lausanne). 2018; 9:617. PMC: 6230581. DOI: 10.3389/fendo.2018.00617. View