[Evaluation of continuous nerve block for postoperative pain management in orthopaedic surgery]. / Evaluation de la mise en place d'un protocole d'analgésie postopératoire par cathéter périnerveux.

OBJECTIVE: After orthopaedic surgery, continuous nerve block analgesia provides effective postoperative pain relief. The practical use of these techniques may present problems. The purpose of this study was to assess the development of continuous block procedure for postoperative pain based on quality standard management and the effectiveness of initial training as an adjunct for introduction of these techniques. MATERIALS AND METHODS: A staff committee of anaesthesiologists established a specific practical working protocol. The medical and paramedical teaching sessions were immediately evaluated using a questionnaire. RESULTS: 214 consecutive patients were included. The incidence of side effects and complications were higher in the beginning of protocol. Constant improvement of these results was observed throughout the study. The rate patients with pain were 10%. The analysis of medical evaluation should permit to determine an acceptable level of quality. Most patients were satisfied with their management. CONCLUSION: Pain management quality assurance program provided an improvement in efficacy of postoperative pain management in our protocol. Further, evaluation may be required to assess the complete benefits of this new protocol as regards postoperative pain.

[Concurrent split-course chemotherapy and radiotherapy for unresectable stage III non-small cell lung cancer: preliminary results of a Phase II study]. / Chimioradiothérapie en split course dans les carcinomes bronchiques non à petites cellules de stade III: résultats préliminaires d'une étude de phase II.

PURPOSE: We initiated at Hospital de Mulhouse a prospective phase II study to assess a split-course concurrent radiochemotherapy in locally advanced non-small cell lung cancer. MATERIALS AND METHODS: From March 1996 to December 1997, 28 patients were included in our study. All patients had a stage III cancer. The chemotherapy scheduled included vinorelbine (20 mg/m2/d, d1 and d5), cisplatin (20 mg/m2/d, from d1 to d5), and 5-Fluorouracil (350 mg/m2/d, from d1 to d5 by continuous infusion). The planned irradiation dose was 12.5 Gy per week with one daily fraction of 2.5 Gy from d1 to d5. Cycles were repeated every four weeks, for four cycles (50 Gy). Patients with a partial or complete response were proposed a fifth cycle. RESULTS: Of the 28 patients of the study, only 27 were analysed; one patient had a metastatic disease at diagnosis. Major hematologic toxicity occurred in 26% of the patients. One to five cycles of chemoradiotherapy were administrated per patient (median: four). Four patients had received fewer than three cycles and their responses were not assessable. Of the 23 patients assessed, 12 responses (52%) were observed, three CR (13%) and nine PR (39%). Median follow-up was 14 months, and median survival 13.5 months. One- and two-year survival rates were respectively 63% and 14%. Local control rates was 11%, and 44% of the patients had a metastatic evolution. CONCLUSION: Very preliminary results of this phase II study are disappointing, and quite inferior to the published results using chemoradiotherapy with conventional or hyperfractionated radiotherapy. Hematologic toxicity is restrictive. This type of chemoradiotherapy cannot be recommended.

Thigh abscess as a complication of continuous popliteal sciatic nerve block.

We present a case report of severe localized infection after continuous popliteal sciatic nerve block. The report highlights the importance of meticulous asepsis and possibly limiting the duration of catheter use.