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Increased electrical nerve stimulation threshold of the sciatic nerve in patients with diabetic foot gangrene: A prospective parallel cohort study

Keyl, Cornelius; Held, Tanja; Albiez, Georg; Schmack, Astrid; Wiesenack, Christoph

European Journal of Anaesthesiology: July 2013 - Volume 30 - Issue 7 - p 435–440
doi: 10.1097/EJA.0b013e328360bd85
Postoperative pain

CONTEXT: Peripheral neuropathy may affect nerve conduction in patients with diabetes mellitus.

OBJECTIVE: This study was designed to test the hypothesis that the electrical stimulation threshold for a motor response of the sciatic nerve is increased in patients suffering from diabetic foot gangrene compared to non-diabetic patients.

DESIGN: Prospective non-randomised trial with two parallel groups.

SETTING: Two university-affiliated hospitals.

PARTICIPANTS: Patients scheduled for surgical treatment of diabetic foot gangrene (n = 30) and non-diabetic patients (n = 30) displaying no risk factors for neuropathy undergoing orthopaedic foot or ankle surgery.

MAIN OUTCOME MEASURE: The minimum current intensity required to elicit a typical motor response (dorsiflexion or eversion of the foot) at a pulse width of 0.1 ms and a stimulation frequency of 1 Hz when the needle tip was positioned under ultrasound control directly adjacent to the peroneal component of the sciatic nerve.

RESULTS: The non-diabetic patients were younger [64 (SD 12) vs. 74 (SD 7) years] and predominantly female (23 vs. 8). The geometric mean of the motor stimulation threshold was 0.26 [95% confidence interval (95% CI) 0.24 to 0.28] mA in non-diabetic and 1.9 (95% CI 1.6 to 2.2) mA in diabetic patients. The geometric mean of the electrical stimulation threshold was significantly (P < 0.001) increased by a factor of 7.2 (95% CI 6.1 to 8.4) in diabetic compared to non-diabetic patients.

CONCLUSION: The electrical stimulation threshold for a motor response of the sciatic nerve is increased by a factor of 7.2 in patients with diabetic foot gangrene, which might hamper nerve identification.

From the Department of Anaesthesiology, Heart Centre Freiburg University, Bad Krozingen (CK, TH, GA) and the Department of Anaesthesiology, Marienhospital Gelsenkirchen, Gelsenkirchen (AS, CW), Germany

Correspondence to Cornelius Keyl, MD, Department of Anaesthesiology, Heart Centre Freiburg University, Suedring 15, 79244 Bad Krozingen, Germany Tel: +49 7633 402 2650; fax: +49 7633 402 2659; e-mail: cornelius.keyl@universitaets-herzzentrum.de

Published online 26 April 2013

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© 2013 European Society of Anaesthesiology