[Fast-tracking and regional anaesthesia: preliminary feasibility study]. / Fast-tracking en anesthésie locorégionale périphérique: étude préliminaire de faisabilité.

OBJECTIVE: The monitoring in the post-anaesthesia care unit (PACU) improves the safety, the comfort and the analgesia of patients. At present, studies suggest the possibility to bypass the PACU according to the principle of fast-tracking (FT). The aim of this study was to evaluate the feasibility and the safety of a simulated protocol of FT after a regional anaesthesia. PATIENTS AND METHODS: Seven hundred patients were prospectively included in this study over a period of 6 months. METHODS: The Withes' scoring system was used for determining when patients could be safely discharged from PACU. We added a variable concerning the monitoring of surgical site. A minimum score of 14 was required on arrival to the PACU to consider a FT. The success rate of blocks, the use of sedation or general anaesthesia were noted. Adverse events were recorded. RESULTS: The success rate of blocks was 93 %. The score was higher than 14 in 98 % of case on arrival to the PACU. Thirteen adverse events were reported before surgery and/or operating room. No adverse events were reported during the stay in the PACU. CONCLUSION: Regional anaesthesia seems to be an appropriate principle to fast-track the PACU. It could be a way to reduce health care costs, and can offer solution for the PACU congestion problem. In France, the fast-tracking is a marginal concept without any support regulatory. An evolution to such a practice could be considered.

The learning process of the hydrolocalization technique performed during ultrasound-guided regional anesthesia.

BACKGROUND: Because poor echogenicity of the needle remains a safety issue, we decided to analyze the learning process of the hydrolocalization technique (Hloc) performed to continuously identify needle-tip anatomical position during many ultrasound-guided regional anesthesia procedures. METHODS: Ten senior anesthesiologists naïve to the Hloc agreed to participate in the study. They were requested to perform 40 out-of-plane (OOP) approach ultrasound-guided axillary blocks (AB) each using the Hloc. The Hloc, which is a needle-tip localization principle, was performed by means of repetitive injections of a small amount of a local anesthetic solution (0.5-1 ml) under an ultrasound beam. Details of the learning process and skill acquisition of the Hloc were derived from the following parameters: the duration of block placement, a measure of the perceived difficulty of needle-tip visualization, a measure of block placement difficulty, and the amount of local anesthetics solution required for the technique. RESULTS: Four hundred ABs were performed. The success rate of an ultrasound-guided AB was 98%. The Hloc was successful in all patients. Skill acquisition over time of the Hloc was associated with a significant reduction of both the duration and the perceived difficulty of ABs placement. Apprenticeship data revealed that 20 blocks were required to successfully place AB within 5 min in most cases using the Hloc. CONCLUSION: The Hloc performed during the OOP approach of ultrasound-guided regional anesthesia is a simple technique with a relatively short learning process feasible for efficient placement of ABs.

[Ultrasound guided regional anaesthesia: an effective method for cleaning the probes]. / Anesthésie locorégionale périphérique sous échographie: efficacité de stratégie de décontamination de la sonde.

OBJECTIVES: The objective of this study was to determine if the ultrasound probe can act as a vector for cross-infection and to compare two cleaning methods for ultrasound probes in order to limit or control the transmission risk. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: The first part of the study (P1) was conducted to evaluate the possibility of the ultrasound probe to serve as a source of cross-contamination. Thirty blocks were placed under ultrasound guidance in elective outpatients. After each procedure (Proc), the ultrasound probe was decontaminated/cleaned using either an antiseptic solution spray (AS: n=15) or just wiped with two dry paper sheets (DP: n=15), in a randomly assigned order. Bacteriological samples were collected before and after each decontamination/cleaning methods and inoculated on a chocolate agar plates. The second part of the study (P2) was conducted to compare the effectiveness of two cleaning methods for ultrasound probes. The ultrasound probes were exposed to a large inoculum of three bacteria (Inoc). They were then cleaned/decontaminated using either DP (n=10) or AS (n=10), in a randomly assigned order. Bacteriological samples were collected before and after each cleaning/decontamination methods and inoculated on a chocolate agar plates. RESULTS: During P1, after Pro, all probes were found to be sterile before and after both AS and DP. During P2, after Inoc, all probes were found infected (CFU>150) but were considered sterile (CFU<10) after both DP and AS. CONCLUSION: The results of this study suggest that the risk of cross-infection during ultrasound guidance in locoregional anaesthesia is really low. Our data suggest that wiping ultrasound probe with two dry paper sheets is an adequate cleaning method to prevent cross-contamination risk.

[Ultrasound-guided infraclavicular block: a preliminary study of feasibility]. / Bloc infraclaviculaire sous contrôle échographique: une étude préliminaire de faisabilité.

OBJECTIVES: To assess the feasibility of neurostimulation and ultrasound guidance combination for infraclavicular brachial plexus block (ICB) technique. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: Fifty consecutive patients scheduled for hand, forearm or elbow surgery were included. METHODS: A single stimulation lateral approach technique of ICB was performed. During the procedure, neurostimulation and ultrasound guidance were combined. The feasibility of ICB was assessed using a visual analogue scale (VAS, 0: impossible, 100: very simple) for ultrasound anatomical structures identification (VAS(Anat)) and for block placement (VAS (Block)). The success rate of ICB block was noted. RESULTS: No patient required general anaesthesia conversion. Median VAS+/-SD of VAS(Anat) and VAS(Block) were of 84+/-15 and 96+/-7, respectively. Success rate of ICB was 96%. No specific complication of ICB technique was noted. CONCLUSION: Combination of neurostimulation and ultrasound guidance is feasible. Combination of neurostimulation and ultrasound guidance secured ICB. Ultrasound-evidenced spread of local anaesthetics increased the success rate of ICB.

[Efficiency of secondary posterior trunk single stimulation, low volume infraclavicular plexus block for upper limb surgery]. / Bloc plexique infraclaviculaire en monostimulation: l'injection au contact du faisceau postérieur permet de réduire le volume d'anesthésique local.

OBJECTIVES: To assess the efficiency of a posterior secondary trunk single stimulation, low volume (30 ml 1.5% mepivacaine) infraclavicular brachial plexus block (ICB) technique. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: One hundred consecutive patients scheduled for hand, forearm or elbow surgery were included. ICB was placed using a single stimulation technique. 30 ml 1.5% mepivacaine was injected when an evoked distal radial motor type response was elicited for 0.3-0.6 mA intensity current. Based upon both sensory and motor distribution ICB, characteristics and performance were assessed. RESULTS: No patient required general anesthesia conversion. Success rate was 92%. 8 patients required a total amount of 10 complementary distal troncular blocks. No specific complication of ICB technique was accoutered. All patients completed full neurological recovery from ICB 24 hours after surgery. CONCLUSION: 30 ml mepivacaine 1.5% ICB is suitable for upper limb surgery.