Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1995
Clinical Trial Controlled Clinical Trial[Efficacy of propacetamol in postoperative pain based on two modes of intravenous administration].
The analgesic and antipyretic efficacy of propacetamol is identical to paracetamol. Because the propacetamol is injectable and its side effects are uncommon and mild, it is the drug commonly used in France for postoperative pain relief. The aim of this prospective study was to compare the analgesic efficacy of propacetamol after breast surgery or thyroidectomy when it was administered either systematically or on the patients demand. ⋯ Pain during propacetamol infusion was more frequent in the D group than in the S group (30% and 13% respectively, p < 0.05). No other adverse effects were observed during the study. Propacetamol alone is sufficient for pain relief after peripheral surgery; more than 90% of patients need no supplemental analgesic, and adverse effects are rare.
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The use of a pneumatic tourniquet to provide a bloodless field in orthopedic surgery is often complicated by tourniquet pain. The mechanism of this pain remains incompletely understood, but it is probably multifactorial. Nerve compression is a common etiologic feature. ⋯ Superficial (skin) compression and deep components compression like blood vessels and muscles can both induce tourniquet pain. Central nervous system can also interfere. Release of tourniquet can increase the pain by post-ischaemic oedema due to ischaemia and reperfusion injury.
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Lumbar plexus block via the inguinal approach is indicated for analgesia following knee surgery. The technique consists in an injection of the anaesthetic solution through a catheter placed into the space limited by the fascia of the iliopsoas muscle. In this area are the different nervous roots which constitute the plexus. A good technique and a good knowledge of the anatomy of this region are necessary for a successful block and for the safety of the patient.
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Cahiers d'anesthésiologie · Jan 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Hemodynamic effect of intrathecal clonidine].
Intrathecal administration of bupivacaine and clonidine results in a significant prolongation of both motor and sensitive blocks but side effects-hypotension and bradycardia-are observed. We compared two groups of patients allocated randomly. ⋯ Some possible explanations are discussed. No complications due to clonidine were observed.
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Regional anaesthesia has been increasingly popular in paediatric patients of all ages, especially because some techniques afford excellent per and post-operative pain relief. However, side effects may occur. Particularly, systemic toxicity from bupivacaine administration is associated with intravascular injection or overdosage. ⋯ Management of the best method of block, doses and local anaesthetics or adjuvants according age, requires likely specific teaching in training team. An effort to provide appropriate guidelines and training to ward nurses is necessary to improve security when regional blockade is used for postoperative analgesia. In every cases, physician's experience is the best argument of choice.