Objective To compare the efficacy of popliteal sciatic nerve block (PSNB) and total intravenous anesthesia (TIVA) during diabetic foot (DF) surgery, and to explore the influencing factors of wound healing.

Methods Clinical data of patients undergoing DF surgery admitted between July 2023 and February 2025 were retrospectively analyzed. Patients were divided into the PSNB group and the TIVA group according to anesthesia method. Intraoperative hemodynamics, postoperative analgesia efficacy [numeric rating scale (NRS) score and patient-controlled intravenous analgesia [PCIA] pressing frequency], and perioperative complications were compared between the two groups. A multivariate Logistic regression model was applied to screen independent influencing factors for wound healing.

Results A total of 205 patients undergoing DF surgery were enrolled, including 129 in the PSNB group and 76 in the TIVA group. Compared with the TIVA group, the PSNB group exhibited more stable intraoperative hemodynamics, markedly lower incidences of hypotension and vasoactive agent administration, as well as shorter operative duration (all P<0.05). Moreover, the PSNB group achieved significantly lower postoperative NRS scores, fewer PCIA compressions, and lower incidences of complications such as aspiration pneumonia and drowsiness (all P<0.05). Multivariate Logistic regression analysis showed that operative time ≥90 min[OR=3.17,95%CI(1.78, 5.56)], age ≥70 years[OR=2.07, 95%CI(1.12, 3.82)], diabetic nephropathy [OR=2.44,95%CI(1.36, 4.37)], and Wagner grade ≥3[OR=2.81,95%CI(1.24, 6.39)]were independent risk factors for complete wound healing, while PSNB[OR=0.36,95%CI(0.20, 0.65)]was an independent protective factor.

Conclusion Compared with TIVA, PSNB has significant advantages in maintaining intraoperative circulatory stability and safety for DF patients. This anesthesia method can not only optimize perioperative management but also is an independent protective factor promoting complete wound healing, with clinical value superior to TIVA. This study is a single-center retrospective analysis, and the conclusions need to be verified by multicenter prospective randomized controlled trials.

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