Cahiers d'anesthésiologie
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In 1986, Reiestad and Strömskag introduced interpleural postoperative analgesia with local anaesthetic solutions. The aim of this review was to describe the physiological mechanisms, indications and limits of this new mechanisms, indications and limits of this new technic. Interpleural analgesia has been successfully used for pain relief after cholecystectomy by subcostal incision. ⋯ After thoracotomy, if this technic seemed to be simple by visual placement of the catheter tips by the surgeon, most of the studies failed to demonstrate reduction of postoperative pain. Finally, interpleural analgesia has recently been shown to be effective in the management in various chronic pain syndromes of the upper abdomen (pancreatitis...) and thorax (postherpetic neuralgia, upper extremity reflex sympathetic dystrophy). The efficacy of this technic for long-term chronic pain involves the blockade of the sympathetic chain of the injected side.
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Cahiers d'anesthésiologie · Jan 1992
Review[Patient-controlled analgesia by the peridural route and classical methods of analgesia].
Patient controlled analgesia was developed to compare drug effects. Later its psychological implications were studied. Drug administration by intravenous or epidural injection has been used. ⋯ Simultaneous use of opioids and anti-inflammatory drugs enhances the analgesic effects. For pain relief in childbirth, opioids need to be combined with local anaesthetics for best results. Little has been achieved by patient controlled analgesia in the treatment of chronic pain.
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Plexus nerve blocks of the lower limb have been described for many years but were seldom used until recently. Postoperative analgesia is one of the main indications of these blocks. The blockade of both lumbar and sciatic plexuses is required for most of the surgical procedures performed on the proximal part of the lower limb. ⋯ Several pharmacokinetic studies have documented that toxic thresholds of plasma concentrations of local anaesthetics are not reached with the doses commonly injected. Many different techniques and landmarks have been described providing several alternatives to perform these blocks according to the type and the localisation of the surgical procedure. Extensive indications are reported for day case surgery or patients at risk.
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Cahiers d'anesthésiologie · Jan 1992
Review[Fetal and neonatal effects of perimedullary opioids used in obstetrical anesthesia].
The use of spinal or epidural narcotics is more and more frequent in obstetric patients since it enhances the analgesia induced by local anesthetics. However, specific information regarding their fetal and neonatal effects is rare. Fetal effects are mainly dependent on the respiratory and hemodynamic maternal effects, and thus usually limited when usual low dosages of intraspinal narcotics are used. ⋯ In contrast, the evaluation of Apgar and neurobehavioral scores, performed for all the narcotics used, shows little changes when low dosages are used. However, the use of larger dosages epidurally is associated with an increased frequency of low neurobehavioral scores. Therefore, the use of low dosages of epidural narcotics is recommended since there is little available information about the risk of neonatal respiratory depression and no clear maternal advantage of higher dosages.