[Patient-controlled analgesia and postoperative pain]. / Analgésie contrôlée par le patient et douleurs postopératoires.

Patient controlled analgesia improves titration of analgesic drugs, minimizing individual pharmacodynamic differences between patients, during the postoperative period. We describe the efficacy and the safety of intravenous PCA, based on the follow-up of 300 patients, recovering from upper and lower abdominal surgery. Successful use of PCA requires the choice of two important parameters: the PCA bolus and the lock-out period. In our experience, we only prescribed morphine, with a PCA bolus of 0.5 or 1 mg and a lock-out period of 5 or 10 minutes. Nurses were educated to change the syringes and to assess analgesia and the respiratory function. Patients were mostly hospitalized in surgical wards and only 16% of patients were treated in an intensive care unit. Patient's acceptance proved to be excellent and only 4 patients were not satisfied with PCA therapy. The incidence of respiratory depression was low (0.02%) and only one patient required naloxone. The side effects were dysphoria, nausea, pruritus and urinary retention; their incidence was low.

[Shoulder surgery using a plexus block: for or against. Against]. / Chirurgie de l'épaule sous bloc plexique: pour ou contre. Contre.

Brachial plexus block is an alternative and elegant procedure for shoulder surgery. Three main concerns have to be considered when this technique is planed. Firstly, large amounts of local anaesthetic solution are necessary to achieve complete blockade of the region especially when the deeper tissues of the shoulder are concerned by the procedure. Secondly interscalenic cervical plexus block produces homolateral phrenic paralysis and may impair respiratory function in patients at risk or when supplemental IV drugs are administered. Thirdly, when nerve lesions of different mechanisms including plexus block itself occur, the origin of the lesion may be difficulty related to its cause. Indications of cervical block are therefore to be considered cautiously when shoulder surgery is performed.

[Regional anesthesia by the caudal route in adults. Apropos of 56 caudal blocks]. / Anesthésie régionale par voie caudale chez l'adulte. A propos de 56 blocs caudaux.

Caudal anaesthesia was described in 1901 but is now essentially used for paediatric surgery. From their experience of 56 caudal blocks in adult patients scheduled for pelvic surgery or endoscopy, the authors discuss the value of this technique. The anatomical and physiological basis and the main guidelines of caudal anaesthesia are recalled through some references.

[Anesthesia in surgery of acoustic neuroma by the trans-petrous approach]. / L'anesthésie dans la chirurgie des neurinomes de l'acoustique par voies trans-pétreuses.

A combined oto-neurosurgical team has operated upon 86 patients with acoustic tumors larger than 2 cm via translabyrinthine (T.L.) approach over a period of two years. Authors describe anesthetic technic and discuss the advantages of T.L. approach versus sub-occipital approach: supine position, unnecessary invasive monitoring, anesthetic safety, no venous air embolism, quick recovery, no vital pulmonary complications.