Hyperbaric prilocaine vs. hyperbaric bupivacaine for spinal anaesthesia in women undergoing elective caesarean section: a comparative randomised double-blind study.

Hyperbaric bupivacaine spinal anaesthesia remains the gold standard for elective caesarean section, but the resultant clinical effects can be unpredictable. Hyperbaric prilocaine induces shorter motor block but has not previously been studied in the obstetric spinal anaesthesia setting. We aimed to compare duration of motor block after spinal anaesthesia with prilocaine or bupivacaine during elective caesarean section. In this prospective randomised, double-blind study, women with uncomplicated pregnancy undergoing elective caesarean section were eligible for inclusion. Exclusion criteria included: patients aged < 18 years; height < 155 cm or > 175 cm; a desire to breastfeed; or a contra-indication to spinal anaesthesia. Patients were randomly allocated to two groups: the prilocaine group underwent spinal anaesthesia with 60 mg intrathecal prilocaine; and the bupivacaine group received 12.5 mg intrathecal heavy bupivacaine. Both 2.5 µg sufentanil and 100 µg morphine were added to the local anaesthetic agent in both groups. The primary outcome was duration of motor block, which was assessed every 15 min after arriving in the post-anaesthetic care unit. Maternal haemodynamics, APGAR scores, pain scores, patient satisfaction and side-effects were recorded. Fifty patients were included, with 25 randomly allocated to each group. Median (IQR [range]) motor block duration was significantly shorter in the prilocaine group, 158 (125-188 [95-249]) vs. 220 (189-250 [89-302]) min, p < 0.001. Median length of stay in the post-anaesthetic care unit was significantly shorter in the prilocaine group, 135 (120-180 [120-230]) vs. 180 (150-195 [120-240]) min, p = 0.009. There was no difference between groups for: maternal intra-operative hypotension; APGAR score; umbilical cord blood pH; maternal postoperative pain; and patients' or obstetricians' satisfaction. We conclude that hyperbaric prilocaine induces a shorter and more reliable motor block than hyperbaric bupivacaine for women with uncomplicated pregnancy undergoing elective caesarean section.

The use of ultrasound in France: a point of view from experienced regional anesthesiologists.

A cross-sectional survey study on French practice in ultrasound-guided regional anesthesia was carried out. A questionnaire (demographic data, assessment of the likely benefits of ultrasonography, and its use in daily practice: blocks and hygiene) was emailed to all members of the French-speaking association of anesthesiologists involved in regional anesthesia. The questionnaire was filled out and returned by 634 experienced anesthesiologists. An ultrasound machine was available in 94% of cases. Ultrasound-guided regional anesthesia has become the gold standard technique for three-quarters of responders. Axillary, interscalene, popliteal sciatic and femoral nerve blocks were performed by more than 90% of responders, most frequently under ultrasound supervision. Conversely, ultrasound guidance was rarely used for spinal or deep nerve blocks. A specific sterile sheath was used in only 43% of cases. The present study confirms that ultrasound guidance has gained in popularity for many superficial, but not deep, regional anesthesia procedures in France.

[Lumbar tattoos and neuraxial anaesthesia in obstetrics: practice survey in Languedoc-Roussillon, France]. / Tatouages lombaires et anesthésie périmédullaire : enquête de pratique dans les maternités du Languedoc-Roussillon.

To determine neuraxial anesthesia practices in obstetric departments in Languedoc-Roussillon in parturient with large lumbar tattoo covering the puncture area. "A prospective anonymous survey was sent to anaesthesiologists" including a clinical case scenario with a tattooed woman. Questionnaire included items on neuraxial anaesthesia in various circumstances, reasons for the decision process, and "consensus management" or not "within the unit". Fifty-four anaesthesiologists answered (response rate: 57%). Fifty-seven percent would perform an epidural anaesthesia (EA) through the tattoo. Thirty-nine percent would not; among which two third only would propose an alternative for EA. Elective or emergency caesarean section would prompt most of the anaesthesiologists to perform a spinal anaesthesia, especially in parturients with Mallampati Class III (93%) versus Class I (70%) airway. Seventy percent of responders reported no consensual management in their unit. Our study illustrates this lack of consensus in obstetrical units and among anaesthesiologists along with a variable attitude linked with the obstetrical and anaesthesiological situation.

[Locoregional anesthesia for pediatric surgery in remote rural settings: experience of an NGO in Bangladesh]. / Anesthésie locorégionale en chirurgie pédiatrique en milieu rural: expérience d'une ONG au Bangladesh.

Performing safe pediatric anesthesia in developing countries is a technical challenge for NGOs working in remote locations. The aim of this study is to describe our experience aboard a hospital ship working off the coast of northern Bangladesh. Anesthesia protocol records for a 3-year period were retrospectively reviewed. A total of 463 procedures were performed with no severe anesthetic complications. Regional anesthesia was performed in 83% of patients. It was carried out alone in 15% of patients and in association with IV or IM ketamine sedation in 68%. General anesthesia was performed using ketamine in 17% of patients. Tracheal intubation was carried out in only 3 cases. These findings indicate that regional anesthesia in association with ketamine as sedation agent is a simple and safe technique for pediatric anesthesia in remote rural settings.

[Anaphylaxis in terminal pregnancy: two case studies and review of the literature]. / Choc anaphylactique au cours de la grossesse à terme. A propos de deux cas et revue de la littérature.

Anaphylaxis is a relative uncommon event in pregnancy that can have serious implications for both mother and foetus. Two cases of grade 3 anaphylactic shock occurring at the end of the third trimester of pregnancy are reported; the causal agents were respectively amoxicillin and suxamethonium. Maternal and foetal outcome was good after adequate resuscitation and caesarean section performed in both cases because of severe bradycardia. A review of the literature confirms the good maternal outcome; neurologic damage in the newborn is frequent. On the basis of physiologic findings degranulation of placental mast cell is evoked in the genesis of birth asphyxia.

[Tumescent infiltrative anaesthesia for mastectomy: about six cases]. / Anesthésie infiltrative tumescente et mastectomie : à propos de six cas.

OBJECTIVE: To assess safety and efficacy of tumescent infiltration of the supraclavicular nerve and the anterior and lateral branches of the intercostal nerves in major breast surgery. METHODS: A retrospective analysis of six selected patients undergoing mastectomy was performed. A mixture composed of 150mg ropivacaine, 400mg of lidocaine and 0.5mg epinephrine diluted in 500ml Ringer's were administered subcutaneously as follows: 80ml along the parasternal line from the second to the sixth intercostal space, 80ml along the mid axillary line from the second to the sixth intercostal space, 80ml along the infraclavicular line, 80ml in the space between the pectoralis muscle and the mammary gland and 80ml in the axilla in case of axillary dissection. RESULTS: This technique achieved effective analgesia in six patients associated with sedation or light anaesthesia; conversion to general anaesthesia or supplementation with local anaesthesia was not required. No complication was observed. No emesis was noted. CONCLUSION: This technique provides adequate peroperative analgesia and is a technically low-risk procedure. Further evaluation of this technique is recommended.