Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1995
Review[Analgesia after surgery of the spine in adults and adolescents].
Postoperative pain after spinal surgeries is highly dependent on the number of vertebrae included in the operation and on its invasiveness, opposing two extremes, discectomies and cyphoscoliosis corrections. Opiates by intravenous route remain the reference, either continuously given in predetermined doses, or better using a patient-controlled device. Nonsteroidal and steroidal anti-inflammatory drugs are widely popular for medical approach of sciatalgia and it is quite logical to use them for reducing, even to suppress, opiates after spinal surgeries. ⋯ Also, epidural clonidine results in excellent pain relief, but is associated with hypotension and marked sedation. In discectomy, injection of dexamethasone into the operative field has been proposed. Whatever the technique used, early diagnosis of neurological complications of spinal surgery should be not ruled out by postoperative analgesia.
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General anaesthesia is often required for burns dressing. Ketamine was the most common agent for carrying out removal of adherent dressings. Disadvantages are delirium on emergence from anaesthesia and prolonged recovery. ⋯ Mean time of recovery was less than 15 min. Unpleasant dreaming occurred in 3 patients only, without agitation. The technique proved to be simple, effective and should revive interest for ketamine in the management of burned patients.
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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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Regional anaesthesia in the setting of pre-hospital trauma care implies adverse conditions. Therefore some practical advices may be useful; avoid spinal or epidural anaesthesia, prefer safer lidocaine. ⋯ Main usable blocks are: brachial plexus block (axillary or interscalenic approach), radial, medial and ulnar nerve blocks, intercostal and interpleural nerve blocks, sciatic and femoral nerve blocks, superior laryngeal nerve block. Using a nerve stimulator is strongly advised in most cases.