Diabetic Peripheral Neuropathy

Type of nerve damage resulting from high levels of circulating glucose causing microvascular injuries to small blood vessels (vasa nervorum) that supply peripheral sensory nerves resulting in decreased sensation in distal extremities, usually in a stocking and glove distribution. Patients have increased risk of tissue ulceration which may progress and ultimately require digit or limb amputation. Other types of neuropathies are possible including damage to the motor and autonomic systems.

Key Anesthetic Considerations:

– Increased risk of peripheral nerve injury after regional anesthesia

– If using nerve stimulators for regional nerve blocks, will need higher current output as nerve electrical stimulation threshold is variable (usually increased), therefore, Ultrasound is preferred to minimize chance of nerve injury

– Increased sensitivity to local anesthetics (LAs) in diabetes, therefore, smaller dose of LA’s required (lower volume, concentration, without additives) and nerve blocks have increased likelihood of being prolonged

– Positioning important as risk of positional nerve injuries also increased

– Avoid placing IV access in distal lower extremities as risk of ulceration and infection in these areas is increased