Diabète et anesthésie locorégionale

Specific recommendations are made for general anaesthesia in patients with diabetes mellitus, as some complications may occur. Neuroaxial and peripheral blocks may avoid some of these complications: oral intake is not disrupted, the risk of difficult intubation is avoided, that of cardiovascular and respiratory complications limited… However, some specific complications related to regional anesthesia may occur in diabetic patients such as neuropathy, infections… A careful clinical examination is required before regional anaesthesia to diagnose a pre-existent neuropathy. Ultrasound guidance might be safer for peripheral nerve block in diabetic patients to avoid nerve injury. Reduction of the overall dose of local anesthetic is a matter of controversy. Diabetes is not considered as an independent risk factor for infectious complication after regional anesthesia but this is also questionable. As for non-diabetic patient, aseptic conditions and antibioprophylaxy or perineural catheter insertion, should be recommended.