[Puncture of the radial vein: a forgotten complication]. / Ponction veineuse radiale superficielle et neuropathie: une complication oubliée.

The superficial radial vein at the lateral edge of the inferior third of the forearm and of the wrist has strong anatomical relationship with the sensory superficial branch of the radial nerve. At this level, any venous puncture may be responsible for a lesion of this superficial part of the radial nerve. We report two cases of dysesthesia in the radial territory after this kind of puncture. This risk should not be neglected and venous puncture should be avoided in this area.

[Analgesia after hip fracture repair in elderly patients: the effect of a continuous femoral nerve block: a prospective and randomised study]. / Analgésie postopératoire par cathéter fémoral après fracture du col du fémur chez la personne âgée: étude prospective randomisée.

INTRODUCTION: The usefulness of peripheral femoral nerve block for pain management after hip fracture has been established. This prospective and randomised study compared the analgesia effect of a continuous femoral nerve block (CF) versus two conventional analgesia procedures after hip fracture. PATIENTS AND METHODS: Patients. (n=62) scheduled for surgery under spinal anaesthesia were prospectively included. After surgery, analgesia (48 hours) was randomised: group FC (femoral catheter, anterior paravascular approach, initial bolus followed by continuous infusion of ropivacaine 0.2%), group P (iv 2 g propacetamol/6 hours), group M (sc morphine, 0.05 mg/kg per 4 hour). Intravenous morphine titration was performed, followed by subcutaneous (sc) morphine every 4 hours according to the VAS score. The primary end-point was the morphine requirements. Secondary end-points were VAS score, side effects, and mortality. RESULTS: Demographic data and surgical procedures were similar between groups. After morphine titration, the VAS pain score did not differ between groups. All patients in-group M received additional morphine. Morphine mean consumption was increased in CF group: 26 mg (5-42) versus P: 8 mg (3-12) (p=0.0001) or M: 19 mg (8-33) (p<0.006) while constipation was decreased in P group vs CF. Percentage of patients requiring no morphine was similar between P (n=6; 28%) and CF (n=6; 28%) and greater than M (n=0; 0%). Hospital discharge, cardiovascular or pulmonary complications and mortality after 6 months showed no statistical difference. CONCLUSION: Continuous femoral nerve block provided limited pain relief after hip fracture did not reduced side effects and induced an expensive cost.

The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects.

UNLABELLED: We investigated the incidence of bacterial and vascular or neurological complications resulting from femoral nerve catheters used for postoperative analgesia. Patients requiring continuous femoral blockade were consecutively included. Using surgical aseptic procedure, 211 femoral nerve catheters were placed (short-beveled insulated needle, peripheral nerve stimulator). After 48 h, each catheter was removed and semiquantitative bacteriological cultures were performed on each distal catheter tip. Postoperative analgesia and antibiotics were standardized. All complications during the insertion of the catheters and postoperatively (after 48 h and 6 wk) were noted. Few initial complications with no immediate or delayed complications were noted (20 difficult insertions, 3 impossible injections, 3 ineffective catheters, and 12 vascular punctures). After 48 h, 208 catheters were analyzed; 57% had positive bacterial colonization (with a single organism in 53%). The most frequent organisms were Staphylococcus epidermidis (71%), Enterococcus (10%), and Klebsiella (4%). Neither cellulitis nor abscess occurred. Three transitory bacteremias likely related to the catheter occurred. After 6 wk, no septic complications were noted. One femoral paresthesia, partially recovered 1 yr later, was noted. We conclude that the risk of bacterial complications is small with femoral nerve catheters, although the rate of colonization is frequent. IMPLICATIONS: In this prospective study, continuous femoral nerve catheters were effective for postoperative analgesia but had a frequent rate of bacterial catheter colonization. We found no serious infections after short-term (2-day) infusion. Side effects were few, but one nerve injury occurred.

[Postoperative locoregional analgesia in the adult: epidural and peripheral techniques. Indications, adverse effects and monitoring]. / Analgésie postopératoire par voie locorégionale chez l'adulte: techniques perimédullaires et périphériques. Indications, effets indésirables et surveillance.

Regional analgesia is a very effective way to treat postoperative pain. Lumbar and thoracic epidural analgesia are well adapted to major abdominal and thoracic surgery. Nevertheless, respiratory side effects induced by opioids are potentially severe and an adequate monitoring is essential. In orthopaedic surgery, perineural blocks are the best technique to manage postoperative pain and perineural catheters may be used. The importance of intra-articular analgesia, simple and safe, is not fully understood. The association of a local anaesthetic inducing a minor motor block and a strong sensitive block (bupivacaine, ropivacaine), with an opioid seems to be the best pharmacologic choice regarding quality of analgesia and safety. Benefits of postoperative regional analgesia on mortality and morbidity are not demonstrated. Medical and nursing staff and specialized units should improve quality of postoperative regional analgesia as well. General guidelines for the practice of regional anaesthesia must be closely followed.