Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1993
Review[Routes of administration of opioids excluding patient-controlled analgesia].
Opioid analgesics can be administered postoperatively by different routes. Pharmacokinetic peculiarities are evoked for the perimedullar, sublingual, oral, rectal, transcutaneous and intranasal ways.
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Recovery period after anaesthesia, even if short in ambulatory surgery, must not be neglected. Most of serious accidents occur in recovery period but recovery assessments are not clearly defined. ⋯ Tests of upper functions also exist but are not commonly and easily used. They don't disclaim physician responsibility and increase his task appreciably.
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Blocking the median, the radial, the ulnar and the musculo-cutaneous nerves, alone or all together provide sufficient anaesthesia for hand and forearm surgery. Because of frequent anatomical variations and the possibility of a double nerve supply in some territories, blockade must be extended to the adjacent nerves. Tourniquet over the elbow is the only limit for these blocks, but they are useful to provide per and postoperative analgesia during general anaesthesia, and in some cases to improve the efficiency of brachial plexus block.
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Cahiers d'anesthésiologie · Jan 1993
Review[The use of locoregional anesthesia in the prevention of postoperative pain].
Preemptive analgesia is a new concept suggesting that postoperative pain may be attenuated if the transmission of pain is blocked before the occurrence of noxious stimuli. The widespread use of regional anesthesia whether or not associated to general anesthesia has contributed to the improvement of postoperative pain both in ambulatory surgery and inpatients. Numerous studies have demonstrated that postoperative analgesia was better after regional anesthesia when compared to general anesthesia. ⋯ In conclusion, the participation of regional anesthesia in preventing postoperative pain remains controversial. Numerous studies are needed in the future. These studies should take into account the above criterias and should include a large number of patients in order to find first the type of surgery that could benefit and second, the preemptive analgesia treatment that should be used in such indications.
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PDPH are not the privilege of spinal anaesthesia, as they can occur in various circumstances including epidural anesthesia, surgical wound of the dura, spinal tap and/or myclography. Diagnosis PDPH can be discussed with four etiologies: cortical vein thrombosis, meningitis, intracranial haematomas (intracerebral, subdural) or migraine. PDPH result from the leakage of CSF via the dural hole, responsible of hypotension of CSF in the subarachnoid compartment. ⋯ After then, epidural blood patch allows 90% success rate. Other therapeutic proposals are discussed. Finally, prevention of PDPH appears to be the keypoint, paying particular attention to the choice of the needle and of the spinal puncture technique.