| Continuous peripheral nerve blocks in hospital wards after orthopedic surgery: a multicenter prospective analysis of the quality of postoperative analgesia and complications in 1,416 patients. | |
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MedLine Citation:
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PMID: 16249678 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Continuous peripheral nerve block (CPNB) is the technique of choice for postoperative analgesia after painful orthopedic surgery. However, the incidence of neurologic and infectious adverse events in the postoperative period are not well established. This issue was the aim of the study. METHODS: Patients scheduled to undergo orthopedic surgery performed with a CPNB were prospectively included during 1 yr in a multicenter study. Efficacy of postoperative analgesia, bacteriologic cultures of the catheter, and acute neurologic and infectious adverse events were evaluated after surgery in 1,416 patients at arrival in the postanesthesia care unit, at hour 1, and every 24 h up to day 5. Risk factors for adverse events were determined using logistic regression. RESULTS: The median duration of CPNB was 56 h. Both general anesthesia and CPNB were performed in 73.6% of the patients. Postoperative analgesia was effective in 96.3%, but an increase in pain scores was noted at hour 24 (P = 0.01). Hypoesthesia or numbness occurred in 3% and 2.2%, respectively, and paresthesia occurred in 1.5%. Three neural lesions (0.21%) were noted after continuous femoral nerve block. Two of these patients were anesthetized during block procedure. Nerve damage completely resolved 36 h to 10 weeks later. Cultures from 28.7% of the catheters were positive. Three percent of patients had local inflammatory signs. The bacterial species most frequently found were coagulase-negative staphylococcus (61%) and gram-negative bacillus (21.6%). A Staphylococcus aureus psoas abscess (0.07%) was reported in one diabetic woman. Independent risk factors for paresthesia/dysesthesia were postoperative monitoring in intensive care, age less than 40 yr, and use of bupivacaine. Risk factors for local inflammation/infection were postoperative monitoring in intensive care, catheter duration greater than 48 h, male sex, and absence of antibiotic prophylaxis. CONCLUSION: CPNB is an effective technique for postoperative analgesia. Minor incidents and bacterial colonization of catheters are frequent, with no adverse clinical consequences in the large majority of cases. Major neurologic and infectious adverse events are rare. |
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Authors:
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Xavier Capdevila; Philippe Pirat; Sophie Bringuier; Elisabeth Gaertner; François Singelyn; Nathalie Bernard; Olivier Choquet; Hervé Bouaziz; Francis Bonnet; |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Anesthesiology Volume: 103 ISSN: 0003-3022 ISO Abbreviation: Anesthesiology Publication Date: 2005 Nov |
Date Detail:
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Created Date: 2005-10-26 Completed Date: 2006-01-25 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: United States |
Other Details:
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Languages: eng Pagination: 1035-45 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France. x-capdevila@chu-montpellier.fr |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Anesthetics, Local Bacterial Infections / epidemiology, microbiology Cross Infection / epidemiology, microbiology Female Humans Logistic Models Male Middle Aged Nerve Block / adverse effects* Nervous System Diseases / chemically induced, epidemiology Orthopedic Procedures* Pain Measurement Pain, Postoperative / drug therapy, etiology* Peripheral Nerves* Postoperative Complications / epidemiology* Prospective Studies Risk Factors |
| Chemical | |
Reg. No./Substance:
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0/Anesthetics, Local |
| Comments/Corrections | |
Comment In:
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Anesthesiology. 2006 Jun;104(6):1347-8; author reply 1348
[PMID:
16732120
]
Anesthesiology. 2005 Nov;103(5):921-3 [PMID: 16249663 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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