Intérêt de la ropivacaïne intra-péritonéale pour l'analgésie post-opératoire après chirurgie par voie coelioscopique

ANGERS-BU Médecine-Pharmacie (490072105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Étude LIROPEP (comparaison de l'analgésie obtenue par infiltration de lidocaïne 1% ou de ropivacaïne 0,75% versus placebo pour les sutures d'épisiotomies chez les parturientes sous analgésie péridurale)

Introduction : sous analgésie péridurale (APD), il existe une hyperalgésie périnéale en post partum. Nous avons voulu montrer sous APD que l'infiltration de la cicatrice d'épisiotomie avec un anesthésique local (lidocaïne 1%, ropivacaïne 0,75% versus placebo) retardait le recours à un antalgique per os. Matériels et méthodes : étude prospective, en double aveugle, randomisée, approuvée par le CPP[Centre Paul Papin]. Après consentement éclairé, les parturientes ayant accouché par voie basse, sans instrumentation, bénéficiant d'une APD et d'une épisiotomie latérale ont été inclues dans trois groupes au moment de l'infiltration de périnéorraphie : placebo, lidocaïne 1% et ropivacaïne 0,75%. La prise en charge des 24 heures a été protocolisée. Le délai de la première demande d'antalgique, l'EVA, la consommation d'antalgiques à H0, 2, 4, 8, 12, 24 et à chaque demande supplémentaire ont été recueillies. A H24, un questionnaire était remis. Résultats : 154 parturientes ont été inclues. Le délai de recours à un antalgique per os était de 16,6h, 17,0h, 13,9h pour le placebo, la lidocaïne, la ropivacaïne (p=0,104). L'EVA moyenne était de 12,37mm +- 9,69, 16,18mm +- 11,48, 16,84mm +- 11,64 pour la lidocaïne, le placebo, la ropivacaïne (p=0,82). La consommation totale d'antalgique per os était de 3,0, 1,9 et 2,6 prises pour le placebo, la lidocaïne, la ropivacaïne (p=0,05). Le coût global (infiltration+antalgiques) était 0,25EUR, 0,52EUR, 4,74EUR pour le placebo, la lidocaïne, la ropivacaïne (p<0,001). Conclusions : la lidocaïne montrait un meilleur rapport bénéfice/risque/coût. Nous recommandons son utilisation pour l'infiltration de l'épisiotomie lorsque la parturiente bénéficie déjà d'une APD.Introduction : under epidural analgesia (EA), a perineal hyperalgesia exists in the post partum period. We intended to show that the infiltration of the episiotomy with a local anaesthetic (lidocaïne 1%, ropivacaïne 0.75% versus placebo), under EA, delayed ingestion of oral analgesic. Materials and methods : double blind randomized prospective study with ethics comitee approval. After enlightened consent, parturients who gave a vaginal birth, without instrumentation, under EA and with lateral episiotomy were included in one of the three following group just before perineal infiltration was performed: placebo, lidocaïne 1% and ropivacaïne 0.75%. The 24 first hours pick-up charge was protocolized. The delay of first analgesic drug request, VAS score, analgesic consumption at H0, 2, 4, 8, 12, 24 and at each further request were recorded. At H24, a questionnaire was completed by each parturient. Results : 154 parturients were included. The delay of oral analgesic drugs demand for placebo, lidocaine 1% and ropivacaïne 0.75% was of 16.6h, 17.0h and 13.9h, respectively (p=0,104). The average VAS score was 12.37mm +- 9.69 for lidocaïne, 16.18mm +- 11.48 for placebo and 16.84mm +- 11.64 for ropivacaïne (p=0,82). The total oral analgesic consumption was of 3.0, 1.9 and 2.6 requirements for placebo, lidocaïine and ropivacaïne, respectively (p=0,05). The global cost (infiltration+oral analgesic) was 0,25EUR, 0,52EUR, 4,74EUR for placebo, lidocaïne, ropivacaïne (p<0,001). Conclusion : lidocaïne showed a best benefit/risk/cost ratio. We recommend its use for episiotomy infiltration when parturient was already under EA.ANGERS-BU Médecine-Pharmacie (490072105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6.35 years (SD 4.50) were included. The incidence of perioperative severe critical events was 5.2% (95% CI 5.0-5.5) with an incidence of respiratory critical events of 3.1% (2.9-3.3). Cardiovascular instability occurred in 1.9% (1.7-2.1), with an immediate poor outcome in 5.4% (3.7-7.5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0.88, 95% CI 0.86-0.90; p<0.0001), medical history, and physical condition (1.60, 1.40-1.82; p<0.0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0.99, 0.981-0.997; p<0.0048 for respiratory critical events, and 0.98, 0.97-0.99; p=0.0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia

Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31â127 anaesthetic procedures in 30â874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0â5·5) with an incidence of respiratory critical events of 3·1% (2·9â3·3). Cardiovascular instability occurred in 1·9% (1·7â2·1), with an immediate poor outcome in 5·4% (3·7â7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10â000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86â0·90; p<0·0001), medical history, and physical condition (1·60, 1·40â1·82; p<0·0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0·99, 0·981â0·997; p<0·0048 for respiratory critical events, and 0·98, 0·97â0·99; p=0·0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia. Funding European Society of Anaesthesiology

Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6.35 years (SD 4.50) were included. The incidence of perioperative severe critical events was 5.2% (95% CI 5.0-5.5) with an incidence of respiratory critical events of 3.1% (2.9-3.3). Cardiovascular instability occurred in 1.9% (1.7-2.1), with an immediate poor outcome in 5.4% (3.7-7.5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0.88, 95% CI 0.86-0.90; p<0.0001), medical history, and physical condition (1.60, 1.40-1.82; p<0.0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0.99, 0.981-0.997; p<0.0048 for respiratory critical events, and 0.98, 0.97-0.99; p=0.0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia