Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Dec 2008
Randomized Controlled Trial[Ropivacaine infiltration during breast cancer surgery: postoperative acute and chronic pain effect].
Decrease acute pain after breast cancer surgery by an infiltration of ropivacaine. Analyse effect on chronic pain. ⋯ Ropivacaine scar infiltration provided no acute or chronic pain relief after breast cancer surgery.
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Ann Fr Anesth Reanim · Dec 2008
Review[Perioperative venous thromboembolism prophylaxis: short review and recommendations].
The overall thromboembolic risk is the resultant of patient-related risk and surgical risk. The surgical risk is decreasing, especially with the introduction of new procedures (fast-track surgery). The value of prophylaxis has been firmly established. ⋯ The relevance of distal vein thromboses is debated. Surrogate venographic end-points should be gradually replaced by a combination of ultrasound and clinical criteria. The new antithrombotic agents will probably modify prevention in the years to come but currently there are very few long-term data for these products for which - it should be reminded - no antagonists are available.
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The knotting of an epidural catheter is a rare complication preventing catheter withdrawal. We report two cases of catheter knotting and subsequent impossible withdrawal with moderate repeated traction. ⋯ The common risk factor found was an excess in catheter length inserted. A surgical procedure was necessary for both patients.
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Ann Fr Anesth Reanim · Dec 2008
Case Reports[Acute renal failure related to urinary retention following haemorrhoidectomy performed under general anaesthesia and bilateral pudendal nerve block: a case report].
Anorectal surgery is associated with significant postoperative pain. Pudendal nerve blocks, formerly performed by surgeons, provides effective postoperative analgesia and allow a quicker recovery, which is quite important in the current concept of fast-track postoperative care. However, even for benign surgery with a safe anaesthetic technique, serious adverse events may occur. ⋯ After complete recovery, electrophysiologic investigations found hypotonic, hypocontractile bladder. Therefore, before performing haemorrhoidectomy with regional anaesthesia, prior history of urination difficulties should be searched. The risk of urinary retention due to surgery and anaesthesia may be increased, as observed in this original case report.
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New oral anticoagulants, soon available in clinical practice, will deeply change the management of venous thromboembolism. The main advantage of these drugs is the route of administration. ⋯ A new era for prophylaxis of VTE is beginning with the new oral anticoagulants. However, improvement in the management of patients with renal failure, obese patients or elderly is needed considering that these patients have a high thrombotic and/or hemorrhagic risk.