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MINERVA ANESTESIOLOGICA

A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2018 Mar 27

DOI: 10.23736/S0375-9393.18.12322-4

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Comparison of axillary nerve block duration using mepivacaine in non-insulin diabetic or renal insufficiency patients: a controlled observational matched multicentre trial

Philippe CUVILLON 1 , Melissa CASIER 1, Christophe DEMATTEI 2, Nathalie BERNARD 3, Christophe BOISSON 1, Nathalie VIALLES 1, Joel LHERMITE 1, Jacques RIPART 1, Xavier CAPDEVILA 3

1 Department of Anesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Nîmes, France; 2 Department of Biostatistics, Epidemiology, Public Health and Medical Information (BESPIM), University Hospital, Nîmes, France; 3 Department of Anesthesiology and Intensive Care Unit, Centre Hospitalier Regional Universitaire (CHRU) Lapeyronie, Montpellier, France


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BACKGROUND: Although studies in diabetic patients demonstrated delayed recovery after long-acting local anesthetic, its effects with short-acting LA remains to be determined. Using mepivacaine, the authors evaluated the duration of axillary nerve blocks in diabetic (DP), renal failure (creatinine clearance < 30 ml.min-1) (RP) and healthy patients (HP).
METHOD: We prospectively included consecutive patients aged 18-80 years, with DP (n=37), RP (n=32) and HP (n=48) scheduled for distal upper limb surgery. Before surgery, an axillary nerve block (20 mL mepivacaine 15 mg.mL-1) was performed with an ultrasound approach combined with nerve stimlulation. Five mL was injected for each nerve: median, ulnar, radial, musculo-cutaneaous nerves. The primary endpoint measured was the duration of sensory block. For statistical analysis, each HP patient was matched with RP and DP patient (1:1),with regards to age (range ± 5 years) and sex.
RESULTS: Patient characteristics were similar between groups. Creatinine clearance was 14±8 mL.min-1 in RP group and HbA1c (%) was 7.5±1.5 in DP group. Mean duration of diabetic or renal insufficiencey illness were respectively 8 and 12 years. Onset time for sensory and motor blocks were similar between groups. Average time for sensory block duration was similar between DP vs HP (235 ± 52 vs 230 ± 54 min, p=0.71) ; and between RP vs HP (234 ± 51 vs 229 ± 57 min, p=0.65).
CONCLUSIONS: The short-acting LA (mepivacaine) are associated with similar pharmacodynamic effects in diabetic and renal failure patients as compared with healthy patients.


KEY WORDS: Peripheral nerve block - Mepivacaine - Diabetes - Renal insufficiency - Regional anesthesia

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Publication History

Article first published online: March 27, 2018
Manuscript accepted: March 14, 2018
Manuscript revised: March 6, 2018
Manuscript received: July 25, 2017

Cite this article as

Cuvillon P, Casier M, Demattei C, Bernard N, Boisson C, Vialles N et al. Comparison of axillary nerve block duration using mepivacaine in non-insulin diabetic or renal insufficiency patients: a controlled observational matched multicentre trial. Minerva Anestesiol 2018 Mar 27. DOI: 10.23736/S0375-9393.18.12322-4

Corresponding author e-mail

philippe.cuvillon@chu-nimes.fr