L’amélioration des techniques d’anesthésie locorégionales ne dispensent pas de la ponction cutanée qui peut être source de douleurs et d’inconfort durant la réalisation du BA. Différents travaux ont montré l’intérêt de l’application de crème lidocaïne-prilocaïne (EMLA®) pour l’anesthésie cutané lors de ponctions cutanées. L’objectif de notre étude était d ‘évaluer l’efficacité analgésique de l’application de crème lidocaïne-prilocaïne lors de la ponction cutanée pour la réalisation de BA. L’étude prospective, monocentrique, contrôlée, randomisée en double aveugle contre placebo a été menée après accord du CPP Ouest III (no 12.05.13) d’août 2012 à juin 2013 au CHU de Poitiers. Quatre-vingt-quatre patients bénéficiant d’un bloc axillaire pour une chirurgie du membre supérieur ont été inclus après recueil du consentement éclairé. Les patients étaient randomisés en 2 groupes : groupe EMLA® avec application de 10 g de crème EMLA® sur le site de ponction du bloc axillaire. Le groupe Placebo avec application de 10 g de crème placebo sur le site de ponction du bloc axillaire. La douleur lors de la ponction cutanée ainsi que la douleur lors de l’injection étaient évaluées par l’EVA. Les données démographiques étaient comparables entre le groupe EMLA® par rapport au groupe Placebo, (âge moyen à 51,1 ± 14,3 ans VS 50,3 ± 16,6 ans ; IMC 26,7 ± 5,3 kg/m2 VS 25,6 ± 4,0 kg/m2 ; un ratio femme/homme 1,7 VS 1,6 ; Les classes ASA étaient similaires). La durée d’application de la crème dans le groupe EMLA® était de 70 ± 45 min VS 75 ± 47 min dans le groupe Placebo ; p = 0,67. La douleur au site de ponction (Fig. 1) était significativement moins importante dans le groupe EMLA® par rapport au groupe Placebo (14,8 ± 12,9 mm vs. 27 ± 17,2 mm ; p = 0,007). La douleur lors de l’injection de l’anesthésique local n’était cependant pas différente entre les groupes EMLA® et Placebo (26,7 mm ± 19,7 vs. 28,5 ± 16,5 mm ; p = 0,36). La crème lidocaïne-prilocaïne diminue la douleur lors de la ponction cutanée. Cette stratégie s’intègre parfaitement dans la prise en charge de la douleur au bloc opératoire.

Objectives. - There are limited data on peripheral nerve block (PNB) practices by residents in France, especially with after introduction of ultrasound. A survey was conducted on PNB practices by French residents.Study design. - Multicenter prospective descriptive study.Patients and methods. - All residents completed a survey form after each PNB procedure.Results. - A total of 394 procedures performed by 21 residents in 4 hospitals were collected. The number of procedures and average volume of local anesthetics by type of block are: axillary block 245-25 mL (62%), interscalene 29-21 mL (7%), supraclavicular 1-25 mL (0.3%), 2-25 mL infraclavicular (0.5%), femoral 65-18 mL (16.5%), sciatic 52-22 mL (13%). Detection was done by ultrasound only for 365 (92.6%) procedures, and neurostimulation only for 23 (5.8%) procedures. The duration of procedure was less than 5 min for 200 (50.7%) procedures and more than 15 min for 16 (4%) procedures. A single puncture was required for 307 (78%) procedures. The initial block success was obtained in 369 (93%) procedures. High training level residents required less time (P < 0.0001), less puncture (P < 0.046) and less neurostimulation use (P < 0.0001) than novices, without difference in success rate and the volume of local anesthetic required.Conclusions. - The majority of procedures performed by the residents are using ultrasound. The procedure is usually fast, requiring mainly a single puncture and has a high rate of success. (C) 2013 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Il existe peu de données sur la pratique de l’anesthésie locorégionale périphérique (ALRp) par les anesthésistes en formation en France, notamment depuis l’utilisation de l’échographie. Nous avons étudié les pratiques en ALRp des internes d’anesthésie-réanimation dans la région Poitou-Charentes. Étude prospective descriptive multicentrique. Les internes en anesthésie-réanimation ont complété un formulaire d’enquête après réalisation d’une ALRp. Un total de 394 procédures ont été réalisées par 21 internes dans quatre hôpitaux. Le nombre et le volume médian d’anesthésique local administré par type d’ALRp sont : axillaire 245–25 mL (62 %), interscalénique 29–21 mL (7 %), supraclaviculaire 1–25 mL (0,3 %), infraclaviculaire 2–25 mL (0,5 %), fémoral 65–18 mL (16,5 %) et sciatique 52–22 mL (13 %). Le repérage a utilisé l’échographie seule pour 365 (93 %) des procédures et la neurostimulation seule pour 23 d’entre elles (6 %). La durée de la procédure a été inférieure à cinq minutes pour 200 (50,7 %) procédures et supérieure à 15 minutes pour seulement 16 d’entre elles (4 %). Une seule ponction a été nécessaire pour 307 (78 %) des procédures. La réussite initiale du bloc a été obtenue pour 369 (93 %) procédures. Les internes en fin de cursus mettent moins de temps (p < 0,0001), ont recours à moins de ponction (p < 0,046) et se servent moins souvent de la neurostimulation (p < 0,0001) sans différence concernant le taux de succès et le volume d’anesthésique local utilisé. La majorité des procédures d’ALRp effectuées par les internes dans la région Poitou-Charentes sont réalisées sous repérage échographique seul. La procédure est rapide, ne nécessitant le plus souvent qu’une seule ponction, et a un taux de réussite élevé, notamment chez les étudiants les plus expérimentés. There are limited data on peripheral nerve block (PNB) practices by residents in France, especially with after introduction of ultrasound. A survey was conducted on PNB practices by French residents. Multicenter prospective descriptive study. All residents completed a survey form after each PNB procedure. A total of 394 procedures performed by 21 residents in 4 hospitals were collected. The number of procedures and average volume of local anesthetics by type of block are: axillary block 245–25 mL (62%), interscalene 29–21 mL (7%), supraclavicular 1–25 mL (0.3%), 2–25 mL infraclavicular (0.5%), femoral 65–18 mL (16.5%), sciatic 52–22 mL (13%). Detection was done by ultrasound only for 365 (92.6%) procedures, and neurostimulation only for 23 (5.8%) procedures. The duration of procedure was less than 5 min for 200 (50.7%) procedures and more than 15 min for 16 (4%) procedures. A single puncture was required for 307 (78%) procedures. The initial block success was obtained in 369 (93%) procedures. High training level residents required less time (P < 0.0001), less puncture (P < 0.046) and less neurostimulation use (P < 0.0001) than novices, without difference in success rate and the volume of local anesthetic required. The majority of procedures performed by the residents are using ultrasound. The procedure is usually fast, requiring mainly a single puncture and has a high rate of success.

INSERM U1070 University Hospital of Poitiers, Department of Anaesthesiology and Intensive Care, Poitiers, France

BACKGROUND Respiratory rate should be monitored continuously in the post-anaesthesia care unit (PACU) to avoid any delay in the detection of respiratory depression. Capnometry is the standard of care but in extubated patients requires a nasal cannula or a face mask that may be poorly tolerated or can be dislodged, leading to errors in data acquisition and false alarms. The value of a new non-invasive acoustic monitor in this setting has not been fully investigated. METHODS Adult patients admitted to the PACU after general anaesthesia were included. After tracheal extubation, an adhesive sensor with an integrated acoustic transducer (RRa™) was placed on the patient's throat and connected to its monitor while the patient breathed through a face mask with a carbon dioxide sampling port (Capnomask™) connected to a capnometer. Both the acoustic monitor and the capnometer were connected to a computer to record one pair of data per second for up to 60 min. RESULTS Fifty-two patients, mean (range) age 54 (22-84) yr and BMI 26 (19-39) kg m(-2), were studied. Compared with capnometry, the bias and limits of agreement of the acoustic method were 0 (-1.4-1.4) bpm. The acoustic sensor was well tolerated while the face mask was removed by eight patients, leading to study discontinuation in two patients. CONCLUSIONS In extubated patients, continuous assessment of respiration rate with an acoustic monitor correlated well with capnometry.

BACKGROUND:Respiratory monitoring is standard after anaesthesia and surgery. Abnormal respiratory rate is a sensitive indicator of respiratory problems, even in patients receiving supplemental oxygen, but the best method for its continuous measurement in spontaneously breathing patients is unclear. This study compared respiratory rate assessment by capnometry using a new oxygen mask with a carbon dioxide sampling port (Capnomask(®)) and thoracic impedance pneumography with clinical measurement (used as a reference method) in extubated patients receiving supplemental oxygen.METHODS:Adult males admitted to the post-anaesthesia care unit after general anaesthesia were studied. Immediately after extubation, a Capnomask(®) connected to a capnometer was positioned appropriately. Respiratory rate was measured by visual inspection of chest movement for 1 min, by capnometry, and thoracic impedance pneumography. One set of measurements was obtained for every patient receiving supplemental oxygen at different flow rates.RESULTS:Twenty men, mean (inter-quartile range) age 54 (23-66) yr and BMI 25 (21-31) kg m(-2), were studied. Compared with visual inspection, the bias and limits of agreement were 0.0 (1.0 to -1.0) bpm for the Capnomask(®) and -2.2 (2.0 to -6.5) bpm for the impedance pneumography. The accuracy of respiratory rate assessment using Capnomask(®) was not influenced by the supplemental oxygen flow rate.CONCLUSIONS:In extubated patients, continuous assessment of respiratory rate with the Capnomask(®) is more accurate than by thoracic impedance pneumography even when supplemental oxygen is delivered at a high flow rate.

We report the case of a 56-year-old man who presented a section of a chest drain into the pleural cavity. Following an oesogastrectomy with coloplasty for oesophageal carcinoma, the patient developed a pleural effusion. During the implementation of pleural drainage, the intrathoracic drain tip was sectioned. The patient underwent a thoracotomy to remove the foreign body. The drain was probably cut during device removal through the particularly cutting trocar. This observation strengthens the need to refrain from withdrawing the movement tube through a Monod trocar.