Cahiers d'anesthésiologie
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The neurophysiologic concept of neuroplasticity represents one of the current basis of the pathophysiology of painful post-injury phenomenons (postoperative, post-traumatic...). Deriving directly from these experimental data, the idea of preemptive analgesia has gradually developed in the last five years, the central question being to know if an analgesic intervention preceding surgical intervention is more efficient, as efficient, or less efficient than the same intervention following surgery. The authors bring current data of the literature in favor of the role of neuroplasticity in the genesis and the persistence of painful states in the course of postoperative outcome. A review of the various clinical studies and controversies published is proposed, in the attempt to make the point on current therapeutic implications of the concept of preemptive analgesia.
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Regional anaesthesia is more and more popular in pediatrics. Many arguments plead for its use. ⋯ So is the quality of intra- and postoperative analgesia. In addition, the few number of complications is also an advantage of regional blocks in children.
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Cahiers d'anesthésiologie · Jan 1995
[Blocking of the brachial plexus: which technique(s) should be chosen?].
Brachial plexus blocks for upper extremity surgery: what are the preferred techniques? Brachial plexus anaesthesia for all types of upper extremity surgical procedures cannot be adequately achieved with a single technique. At least, two approaches are required: above the clavicle, Winnie's interscalene brachial plexus block, using a neurostimulator, has become the standard technique for shoulder surgery. Below the clavicle, midhumerus approach is the most successful approach for elbow, fore arm and hand surgery, especially for outpatient surgery. ⋯ The supraclavicular approach using surface landmarks might be the best approach due to its efficacy in achieving complete anaesthesia of the upper extremity and the rarity of secondary displacement of the catheter. Whatever the selected approach(es) to brachial plexus nerves, nerve location it best achieved by neurostimulation and often multiple neurostimulation. Insulated needles are being increasingly used due to accuracy but, currently, there is no general agreement concerning the type of needle bevel to be preferred in regard to both safety and accuracy.
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Cahiers d'anesthésiologie · Jan 1995
[Penile block. Block of ilio-inguinal and iliohypogastric nerves in children. Techniques, indications, advantages and adverse effects].
Peripheral blocks as penile blocks, ilio-inguinal ou ilio-hypogastric nerve blocks provide an useful alternative to caudal block in children, especially for penile surgery, herniotomy, and orchidopexy, frequently performed at this age. A precise anatomic location and a strict technique increase the success rate of these blocks. ⋯ Postoperative analgesia in ambulatory surgery is one of the best reasons to select these techniques. In addition they avoid prolonged motor effects observed with epidural anaesthesia.
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The placental transfer of local anaesthetics (LA) depends on maternal, placental and fetal factors. The assessment of effects of LA and epidural anaesthesia (EA) on the fetus is based on the monitoring of fetal heart rate (FHR) and the measurement of the fetal pH. Apgar score and neurobehavioral tests allow an evaluation of the neonatal effects of the drugs used. ⋯ Neurobehavioral scores are better after EA than after GA. For emergency caesarean section, the percentage of newborns with an Apgar score < 4 or necessitating a respiratory assistance is more important after GA than after EA. However, the perinatal mortality is not more important after GA than after EA.