scholarly journals Use Of Regional Anesthesia For Lower Extremity Amputation May Reduce The Need For Perioperative Vasopressors: A Propensity Score-Matched Observational Study

2019 ◽  
Vol Volume 15 ◽  
pp. 1163-1171 ◽  
Author(s):  
Seon Ju Kim ◽  
Namo Kim ◽  
Eun Hwa Kim ◽  
Yun Ho Roh ◽  
Jeehyun Song ◽  
...  
2020 ◽  
Vol 45 (6) ◽  
pp. 399-404 ◽  
Author(s):  
Hiroaki Abe ◽  
Masahiko Sumitani ◽  
Hiroki Matsui ◽  
Shotaro Aso ◽  
Reo Inoue ◽  
...  

Background and objectivesThe health benefits of peripheral nerve block (PNB) on postoperative complications after lower extremity amputation (LEA) compared with general anesthesia (GA) remains controversial. We performed a retrospective propensity score-matched cohort analysis to compare major outcomes after LEA with PNB versus GA.Materials and methodsWe used a nationwide inpatient database in Japan to compare patient outcomes after LEA with PNB versus GA from 2010 to 2016. Our primary outcome was 30-day mortality after LEA. The incidence of composite morbidity from life-threatening complications and of delirium within 30 days after LEA were secondary outcomes. We conducted propensity score-matched analyses of patients who underwent below knee or foot amputation using 36 covariates. Logistic regression analyses fitted with generalized estimating equations were performed to calculate ORs and their 95% CIs.ResultsOf 11 796 patients, 747 received PNB and 11 049 received GA. After one-to-four propensity score matching, 747 patients were included in the PNB group and 2988 in the GA group. The adjusted ORs for postoperative mortality, composite morbidity and delirium within 30 days after LEA were 1.11 (95% CI 0.75 to 1.64), 1.15 (95% CI 0.85 t o1.56) and 0.75 (95% CI 0.57 to 0.98), respectively, for the PNB group with reference to the GA group.ConclusionsThere was no significant difference between groups in 30-day mortality or composite morbidity. The PNB group showed a significantly lower risk of postoperative delirium than the GA group. Our findings suggest that PNB may have advantages over GA in preventing postoperative delirium among patients undergoing LEA.


2017 ◽  
Vol 102 (3-4) ◽  
pp. 178-183
Author(s):  
Beliz Bilgili ◽  
Murat Haliloglu ◽  
Erdem Edipoglu ◽  
Halil Cetingok ◽  
Yaser Pektas ◽  
...  

This study aimed to determine the appropriate anesthetic technique for patients who underwent amputation due to peripheral vascular disease. The anesthetic technique to be applied during lower extremity amputations in geriatric patients with limited functional capacity may be important in terms of clinical outcomes and mortality rates. Patients aged older than 65 years who had undergone major lower extremity amputation were retrospectively evaluated. The patients were divided into 2 groups: regional anesthesia (RA) and general anesthesia (GA). Demographic characteristics, comorbidities, medications used, anesthesia technique, the durations of anesthesia and surgery, need for blood transfusion, 30-day mortality, postoperative cardiac and pulmonary complication rates were recorded from the medical records of the patients. Among the 441 patients, 244 had received RA, while 197 had received GA. The average length of stay in the hospital was longer in the GA group (P = 0.001). The use of antiplatelet drugs (P = 0.001) and the number of transfusions were higher (P = 0.045) in the GA group. No significant difference was found between the groups in terms of mortality and postoperative cardiac or pulmonary complication rates. We determined that the anesthesia technique does not have an effect on 30-day mortality and complication rates. The regional anesthesia technique may be preferred in geriatric patients who will undergo major lower extremity amputation because of the shorter hospital stay and theoretical advantages. However, considering the general functional status of patients, the importance of patient-based evaluation should not be forgotten.


2019 ◽  
Vol 0 (4(89)) ◽  
pp. 81
Author(s):  
Н. А. Мамай ◽  
С. М. Войтенко ◽  
С. В. Тертишний ◽  
Д. О. Тимчишин

Author(s):  
Bhavkaran Singh Bal ◽  
Gagan Khanna ◽  
Aditya Bhardwaj ◽  
Kamalpreet Singh

Background: The present prospective observational study was done to analyse the risk factors leading to minor or major lower extremity amputation (LEA) in diabetic patients.Methods: A 139 patients were divided into Group A (n=113) and Group B (n=26) who underwent minor and major LEA respectively.Results: Majority of the patients in group B were from rural and lower socioeconomic background.  Duration of diabetes (p=0.017) and  of DFU was significantly longer in group B (P <0.001) The pro-portion of patients with Wagner Grade 4 and 5  ulcer were significantly higher in group B than in group A (P <0.001) Wound infection and maggots were significantly higher in group B though polymicrobial infection was higher in group A. Biochemical investigations were abnormally altered but difference between two groups was not significant.Conclusions: Socioeconomic burden on the society due to LEA can be reduced by making diabetic patients aware of foot hygiene, regular medical check-up for control of diabetes and associated complications.


2006 ◽  
Vol 34 (5) ◽  
pp. 379-438 ◽  
Author(s):  
Diane M. Collins ◽  
Amol Karmarkar ◽  
Rick Relich ◽  
Paul F. Pasquina ◽  
Rory A. Cooper

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1497-P
Author(s):  
HONGJIANG WU ◽  
AIMIN YANG ◽  
ERIC S. LAU ◽  
RONALD C. MA ◽  
ALICE P. KONG ◽  
...  

Diabetes ◽  
1993 ◽  
Vol 42 (6) ◽  
pp. 876-882 ◽  
Author(s):  
J. S. Lee ◽  
M. Lu ◽  
V. S. Lee ◽  
D. Russell ◽  
C. Bahr ◽  
...  

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