[Neostigmine added to bupivacaine in axillary plexus block: which benefit?]. / Adjonction de la néostigmine au cours du bloc plexique par voie axillaire: quel bénéfice ?

INTRODUCTION: Recent study showed that neostigmine (500 microg) by intra-articular produces postoperative analgesia without adverse effect. The author's goal was to determine whether 500 microg of neostigmine added to bupivacaine in axillary plexus block could prolonged postoperative analgesia without increasing the incidence of side effects. METHODS: Ninety patients scheduled for orthopedic or plastic surgery with axillary plexus block were randomly assigned to one of 3 groups : group 1 (TGr n = 30) received saline solution (1 ml) in the axillary plexus, group 2 (NAGr n = 30) received 500 microg (1 ml) neostigmine in the axillary plexus and group 3.500 microg neostigmine subcutaneously (NSGr n = 30). We evaluated visual analog pain scores (VAS), the consumption of the ketoprofene, nausea and vomiting incidence during the first 24 h. ANOVA, Kruskall Wallis and Fisher tests were used for statistical analysis. A p value of <0.05 was considered significant. RESULTS: The VAS score was lower in NAGr (21 +/- 18) vs NSGr (31 +/- 14) and control group TGr (45 +/- 2) (p < 0.05). The consumption of the ketoprofene is 127 +/- 65 mg in NAGr vs 150 +/- 53 mg in NSGr and 200 +/- 50 mg in group TGr (p = 0.02). Incidence of nausea and vomiting was 3.5% in NAGr vs 6.8% in NSGr and 0% for TGr. CONCLUSION: Neostigmine combined to a mixture of lidocaine and bupivacaine prolongs postoperative analgesia after axillary plexus block.

[Enterocystoplasty complications at the intensive care setting]. / Complications de l'entérocystoplastie en milieu de réanimation.

The cystectomy with substitute enterocystoplasty because of the bladder cancer is a surgical technique which is the origin of several problems that the medicosurgical team faces. The aim of this study is to evaluate the postoperative complications of this surgical technique. We have realized a retrospective study of 56 patients hospitalized in intensive care service between 1994 and 1997. The complications observed were dominated by postoperative peritonitis (5.2%), urinary fistula (3.5%), digestive fistula (1.7%). Other general complications were recorded as pneumopathy (3.5%), digestive hemorrhage (1.7%) and dehydratation (3.5%). One death case in multivisceral failure system was noticed. A precocious diagnosis, a good preoperative value, and a preoperative adapted supervision should improve surely the prognosis.

[Addition of clonidine to 0.5% lidocaine for intravenous locoregional anesthesia]. / Adjonction de clonidine à la lidocaïne à 0,5% pour anesthésie locorégionale intraveineuse.

OBJECTIVE: Evaluate the effect of the addition of clonidine to lidocaine on postoperative pain after intravenous regional anaesthesia. STUDY DESIGN: Double blind prospective study. PATIENTS AND METHODS: Forty-five patients were randomly allocated to two groups: group 1 (n = 25) receiving 3 mg.kg-1 of lidocaine 0.5% added to saline and group 2 (n = 20) receiving 3 mg.kg-1 of lidocaine 0.5% added to clonidine (150 micrograms). Postoperative analgesia was assessed using a visual analogue pain score (VAPS) and the time to first analgesic request. The incidence of side effects after tourniquet release was noted. Analysis of variance, Kruskall Wallis and chi 2 tests were used for statistical analysis. A p-value of < 0.05 was considered significant. RESULTS: Age, ASA class, duration and type of surgery, tourniquet time and sensory block duration were comparable for the two groups. The time to first antalgic request after deflation of tourniquet was similar in the two groups (38 +/- 15 min versus 44 +/- 19 min), while VAPS score was lower (p < 0.05) in the clonidine group (5.2 versus 6.8). The incidence of side effects was comparable in the two groups. CONCLUSION: The addition of clonidine (150 micrograms) to lidocaine for intravenous regional anaesthesia improved postoperative analgesia but in a limited and short-lasting manner.

[Asphyxiating intra-alveolar hemorrhage: a rare form of fat embolism syndrome]. / Hémorragie intra-alvéolaire asphyxiante: forme rare du syndrome d'embolie graisseuse.

We report a case of a 23-year-old patient admitted for a right femur fracture resulting from a traffic accident. An intra-alveolar haemorrhage occurred 48 hours later, with asphyxia anaemia, haematic bronchial aspirations, and bilateral alveolar opacities at chest X-ray. This symptomatology was associated with fever, sub-conjunctival petechiae, major hypocholesterolemia, deterioration of renal function, and cholestasis. All these features suggested a fat embolism. Other possible aetiologies were discarded because of normal cardiovascular and immunologic systems and absence of infection. The outcome under symptomatic treatment was satisfactory within 15 days. The occurrence of intra-alveolar haemorrhage in post-traumatic fat embolism is a rare event caused by pulmonary capillary obstruction by fat emboli.

[Acute obstructive renal insufficiency and pregnancy. Apropos of a case]. / Insuffisance rénale aiguë obstructive et grossesse. A propos d'un cas.

Acute renal failure caused by obstruction by the gravid uterus is a rare complication of pregnancy. We report a case of obstructive acute renal failure in a patient at 28 weeks of gestation. Serum creatinine was 65 mg/l. Ultrasound examination showed a solitary right kidney. The course was marked by premature delivery. Renal function spontaneously returned to normal. This case suggests that acute obstructive uropathy should be considered to be a physiological phenomenon, especially on the right side.

[Local digital anesthesia using lidocaine with or without bicarbonate. A comparative randomized study]. / Anesthésie locale digitale par lidocaïne avec et sans bicarbonate. Etude comparative randomisée.

PURPOSE OF THE STUDY: Local anesthesia with lidocaine is widely used in surgery of the extremities, particularly for fingers. Injection causes pain. In order to minimize this discomfort, addition of bicarbonate has been used by many authors. Results were however contradictory in relation with the difference of approaches. Our study is based on a randomized comparative series with and without lidocaine alcalinization. MATERIAL AND METHODS: Sixty patients presenting multidigital trauma concerning at least two fingers. For each patient, one finger was anesthetized by lidocaine 2 per cent alone and one by lidocaine 2 per cent plus bicarbonate 8.4 per cent respectively in proportion of 4/5 and 1/5. We compared the intensity of pain during injection by a scale ranging from 0 to 10. RESULTS: Significant difference was found between both groups (p < 0.001), alcalinization appearing to decrease discomfort during injection. DISCUSSION: Mechanism of pain decrease by alcalinization is unclear. It appears that intracellular passage of non ionic form of lidocaine is facilitated by alcalinization. This allows the decrease of latence of lidocaine and relieve pain more rapidly by pain receptors blockade. CONCLUSION: Diminution of pain during anesthetic injection has major advantage in out-patient surgery of extremities, in ligamentar testing of digital articulations and in steroid injection.

[Tetraplegia following cervical stab wound]. / Tétraplégies consécutives à une plaie cervicale par arme blanche.

We report two cases of tetraplegia caused by cervical stab wounds. In the first one, in a 34-year-old patient, the injury caused an immediate tetraplegia from cervical spine section and had a rapid lethal outcome. The second case occurred in a 30-year-old woman, who experienced a progressive tetraplegia associated with a Brown-Séquard syndrome from an oedema of the bulbo-spinal junction. Three months later, the motor recovery was satisfactory, however a thermo-algesic hemi-anaesthesia still persisted after the 6th month.