[Analgesia with intra-articular injection of buprenorphine after surgery of the shoulder]. / Analgésie par injection intra-articulaire de buprénorphine après chirurgie de l'épaule.

The effect of 10 ml of intra-articular buprenorphine (0.30 mg) or normal saline on postoperative pain after shoulder surgery was studied in a randomized, prospective, double-blind study in 30 ASA I-II patients receiving general anaesthesia. The pain scores (Five Point Scale ranging from "no pain" to "unbearable pain" and Visual Analog Pain Scale) 1, 2, 3, 4, 6 and 24 hours after surgery, time to first analgesic use and total 6-hours and 24-hours analgesic requirements were recorded. VAPS was significantly lower in the buprenorphine group compared with placebo-treated patients one hour after surgery (p < 0.05). The time to first analgesic use was longer and total 6-h opioid requirements were lower in the buprenorphine group when compared with the control group (p < 0.05). No significant differences were detected in total 24-h analgesic requirements between the two groups. These results indicate that intra-articular injection of buprenorphine after shoulder surgery provides short analgesia. This effect may be mediated by systemic absorption.

[Loco-regional anesthesia and orthopedic surgery of the shoulder]. / Anesthésie loco-régionale et chirurgie orthopédique de l'épaule.

Interscalene block can induce by itself anesthesia for shoulder surgery, if the opening does not reach the delto-pectoral site nor the shoulder-blade, but medical indications must be thoroughly talked over on account of the risk of phrenic paralysis with patients suffering from breezing trouble, and the surgical position that may disturb the anesthesiologist in case he has to increase anesthesia. A superficial cervical plexus block is required in anesthesia of the upper part of the shoulder. Regional anesthesia is quite useful too as a complement to general anesthesia, for it provides excellent postsurgical analgesia. A catheter may be inserted at the end of the surgical process through a nerve stimulator, but the patient does not tolerate it long, its efficiency greatly diminishes after the first day, and paresthesias may occur as after-effects. Today we prefer set interscalene block before the patient is anaesthetized, searching for paresthesias with a thin needle: this process does not take long to install, it is relatively painless and provides excellent analgesia during the per and post-surgical period, until the next day with long acting local anesthetics. Not any complication happened in fifty patients for one year.

[Double-blind randomized clinical study of a droperidol-fentanyl combination]. / Etude clinique randomisée en double aveugle de l'association dropéridol-Fentanyl.

Droperidol 1:50 given with Fentanyl increases the analgetic action of the latter by one third. This effect is not enhanced by increasing the dosage of droperidol.