[Peripheral nerve block in orthopaedic surgery: multicentric evaluation of practicing professionals and impact on the activity of the recovery room]. / ALR périphérique en orthopédie: évaluation multicentrique des pratiques et impact sur l'activité de la SSPI.

OBJECTIVES: Since the last national survey on evaluation of professional practice in France, many peripheral nerve blocks techniques were developed. The aim of this study was to assess the place of such techniques and their impact on the stay in recovery room after orthopaedic surgery. STUDY DESIGN: Prospective, multicentric study. PATIENTS AND METHODS: Consecutive patients receiving a regional anaesthetic technique for orthopaedic surgery over a 15-day period were included in this multicenter study (four private clinics, two non-university and three university hospitals). Characteristics of blocks, duration of stay and activity of nurses in post-anaesthetic care unit (PACU) were recorded for each patient. RESULTS: A total of 289 blocks performed in 283 patients were analyzed. A regional anaesthetic technique was performed alone or associated with a light sedation (58 and 8% respectively) or with a general anaesthesia (44%). A continuous peripheral nerve block (mainly for femoral and iliofascial blocks) was performed in 25% of patients, mostly in university hospital and private clinics (35 and 26% respectively), but only in 3% of cases in non-university hospital. Mean duration of PACU stay was 64+/-67 minutes. This time was longer when regional anaesthesia was associated to or performed after general anaesthesia. Workload of nurses was a simple supervision in 47% of the cases (in 61% of patients receiving regional anaesthesia alone vs 21% in those with general anaesthesia, p<0.05). CONCLUSION: This survey confirms that peripheral nerve block became widely used in orthopaedic surgery. This decreases the medical workload in PACU, especially for distal upper limb surgery. Regional anaesthetic techniques must be well taught during formation cursus of residents.

[Continuous lumbar plexus block sets in France. Our experience]. / Cathéter lombaire par voie postérieure : échec technique lié au matériel.

The undeniable postoperative analgesia brought by the lumbar plexus block among patients scheduled for major surgery of the hip or knee justifies, the setting of a catheter to allow a continues analgesia more durable. Having drawn aside the difficulties of the daily practice (in allusion to the number of blocks carried out per day) and anatomical variations, the failure of the perineural catheter setting is in direct relationship with the material used by the anaesthesiologists for neurostimulation. The presentation of a case report describes a failure of catheter introduction due to the canula in deep continuous blocks, and the advantages and disadvantages of the various sets of neurostimulation. The authors conclude that the sets with the "catheter through the needle" are to be recommended, particularly the stimulating Tuohy needle.