Lalubrification de la sonde d'intubation avec du gel hydrosoluble ne gène pas la diffusion de la lidocaïne bicarbonatée à travers le ballonnet

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Evaluation de l'introduction de la Prégabaline dans l'arsenal thérapeutique au sein d'un centre d'évaluation et de traitement de la douleur

RENNES1-BU Santé (352382103) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

Opioid-free anesthesia: a different regard to anesthesia practice.

In the past two decades, opioids have been prescribed increasingly for the treatment of various chronic pain conditions and during the perioperative period. Perioperative opioid administration is associated with well known adverse effects and recently to long-term use and poor surgical outcomes. In this context, the anesthesiologists have to face their responsibilities. The review discusses the neurophysiological basis of opioid-free anesthesia (OFA), the rational supporting its use in perioperative medicine as well as barriers and future challenges in the field. OFA has gained in popularity as a way to enhance early recovery and to spare opioids for the postoperative period. Whether it is possible to deliver safe and stable anesthesia without intraoperative opioids to many patients undergoing various surgical procedures, OFA still raises questions. Accurate monitoring to measure intraoperative nociception and guide the use of adjuvants are not available. There is a need for the development of procedure-specific strategies as well as indications and contraindications to the technique. Finally, objective assessment of OFA use on patient outcomes should be recorded in large multicenter studies. OFA stands as a new paradigm, which questions anesthesiology practice and might help to rationalize perioperative opioids use

Carence en polyamines (une nouvelle approche dans le traitement de la douleur ?)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

The nerve: A fragile balance between physiology and pathophysiology.

International audienceRegarding nerves as simple cables and electrical conduits is a gross error that does not allow us to understand the anomalies and disorders observed postoperatively. Instead, nerves should be seen as a living tissue of which physiological regulation is as complex as that of the blood-brain barrier. This review describes the basic structure and functions of this blood-nerve barrier and highlights the mechanisms of its breakdown and the resultant disorders. For clinical practice, it is important to note that the diffusion of molecules from the perineurium or from the blood is very limited, and so the blood-nerve barrier is a major pharmacologic barrier. Any stress upon neural physiological balance, particularly the terminal vascular blood supply, will induce the classic inflammatory cascade. Due to the complexity of the vascular system, nerve ischaemia will occur more quickly when the terminal blood supply is compromised. This blood supply can adapt in a variety of ways but when these possibilities of adaptation are exceeded, tissue ischaemia may be more extensive. Also, even after the initial injury has subsided, inflammation can cause a secondary insult. This could be particularly important in some patients with subclinical neuropathy

Evaluation pré-clinique de systèmes thérapeutiques microparticulaires à libération contrôlée de bupivacaine dans les techniques d'anesthésie loco-régionale périphérique

RENNES1-BU Santé (352382103) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

EFFICACITE DE L'INFILTRATION DE ROPIVACAINE POUR LA PRISE DE GREFFON OSSEUX ILIAQUE SUR L'ANALGESIE POSTOPERATOIRE

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

EFFET D'UNE PREMEDICATION AU TEMGESIC* SUR L'INCONFORT DU PATIENT LORS DU BLOC HUMERAL

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Ultrasound Guided Lateral Infra-trochanteric Sciatic Nerve Blockade for Proximal Tibial Surgery: A Novel Technique

The lateral infratrochanteric SNB provides anesthesia of the proximal tibial structures innervated by the sciatic nerve to the same degree as other proximal SNB techniques, therefore it is suitable for the anesthesia for near the knee surgeries. It does not require any special patient positioning as other proximal SNB techniques, which makes it useful in in the setting of acute trauma, fracture and back injury where neuraxial anesthesia is relatively contraindicated and also in in the morbidly obese. Ultrasound probe placement, visualization of the sciatic nerve and nerve block needle placement is technically easier than the anterior SNB approach and is not influenced by body habitus. The injection point on the lateral side of the thigh is easily accessible for signs of bleeding and infection and is therefore suitable for continuous nerve block catheter placement. The catheter is less apt to migrate and the lateral positionoing also reduces risk of infection that may occur with the anterior or other proximal SNB technique