Cahiers d'anesthésiologie
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In 1986, Reiestad and Strömskag introduced interpleural postoperative analgesia with local anaesthetic solutions. The aim of this review was to describe the physiological mechanisms, indications and limits of this new mechanisms, indications and limits of this new technic. Interpleural analgesia has been successfully used for pain relief after cholecystectomy by subcostal incision. ⋯ After thoracotomy, if this technic seemed to be simple by visual placement of the catheter tips by the surgeon, most of the studies failed to demonstrate reduction of postoperative pain. Finally, interpleural analgesia has recently been shown to be effective in the management in various chronic pain syndromes of the upper abdomen (pancreatitis...) and thorax (postherpetic neuralgia, upper extremity reflex sympathetic dystrophy). The efficacy of this technic for long-term chronic pain involves the blockade of the sympathetic chain of the injected side.
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The physiological basis of neurostimulation is recalled and its use for the placement of needles for neural blockade described. After an account of available equipment, the author gives his reasons for preferring some of it. ⋯ The indication for the use of neurostimulation in the practice of infiltration anaesthesia are enumerated and its advantages stressed. Finally its limitations and complications are presented.
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Cahiers d'anesthésiologie · Jan 1992
Review[Patient-controlled analgesia by the peridural route and classical methods of analgesia].
Patient controlled analgesia was developed to compare drug effects. Later its psychological implications were studied. Drug administration by intravenous or epidural injection has been used. ⋯ Simultaneous use of opioids and anti-inflammatory drugs enhances the analgesic effects. For pain relief in childbirth, opioids need to be combined with local anaesthetics for best results. Little has been achieved by patient controlled analgesia in the treatment of chronic pain.
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Cahiers d'anesthésiologie · Jan 1992
Randomized Controlled Trial Comparative Study Clinical Trial[A comparative study of the cost of open-circuit as opposed to closed-circuit ventilation].
The authors compared two open randomized groups of patients undergoing surgery through general anaesthesia. Group 1 consisted of 54 patients ventilated by a Siemens 900 B ventilator in open circuit, and group 2, 56 patients ventilated by an ELSA de Gambro ventilator in a closed circuit. Comparative hour cost for nitrous oxide (N2O), oxygen (O2) and halogen gas, Enflurane, Isoflurane, was noted. ⋯ In order to improve the effective cost of close circuit, the authors proposed: the use of closed circuit ventilation for more than 3 hours surgery, gas saturation in closed circuit after denitrogenation--which demands the use of halogen infjectors, and lime in containers cheaper than disposable cartridges. Respecting the above criteria, the total hour cost in close circuit fell to 4.90 FF, gain of 63% against open circuit. For O2 et N2O, the hour cost goes from 1.34 FF in close circuit to 13.28 FF in open circuit, 90% economy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Plexus nerve blocks of the lower limb have been described for many years but were seldom used until recently. Postoperative analgesia is one of the main indications of these blocks. The blockade of both lumbar and sciatic plexuses is required for most of the surgical procedures performed on the proximal part of the lower limb. ⋯ Several pharmacokinetic studies have documented that toxic thresholds of plasma concentrations of local anaesthetics are not reached with the doses commonly injected. Many different techniques and landmarks have been described providing several alternatives to perform these blocks according to the type and the localisation of the surgical procedure. Extensive indications are reported for day case surgery or patients at risk.