Bloc sciatique en médecine préhospitalière

Objectives

Evaluate the analgesic efficiency of the sciatic nerve block in prehospital care at the time of some severe legs or feet traumas.

Patients and methods

Retrospective, monocentric study upon a period of time 1998–2008.

Results

Twenty-three sciatic nerve blocks have been colligated, five by upper way and heighten by lateral popliteal lower way among which fourteen without neurostimulator. The pain decrease evaluated by the EVS at T0 (before block), T1 (10 min after block) and T2 (arriving in emergency department), has been significative, whatever the measure time interval (T0–T1, T0–T2, T1–T2), the ways used and the local anaesthetics given. The analgesia installation was faster when approaching the sciatic nerve block by the upper way and when using a neurostimulator. Only one analgesic failure was observed while doing a lateral popliteal way without neurostimulator. Any complication was reported.

Conclusion

The sciatic nerve block done in prehospital shows a significant analgesic efficiency which would worth a deeper evaluation and a thought on its introduction in the ED physician's therapeutic gear.     

Abord de la veine sous-clavière par voie sus-claviculaire sous échographie : une nouvelle approche en pédiatrie

The subclavian vein (SCV) is often the preferred site for long-term central venous catheterization in children. It has many advantages over the internal jugular vein. But with the classical landmark technique for SCV catheterization the ultrasound-guidance technique is usually not suitable, because of the clavicle (a bright hyperechoic structure with an acoustic shadow beneath it). Because the SCV can easily be visualized via a supraclavicular approach, we developed a useful ultrasound-guided approach for SCV catheterization in infants and children.     

Anatomie fonctionnelle du nerf cochléaire et du système auditif central

The auditory pathways are a system of afferent fibers (through the cochlear nerve) and efferent fibers (through the vestibular nerve), which are not limited to a simple information transmitting system but create a veritable integration of the sound stimulus at the different levels, by analyzing its three fundamental elements: frequency (pitch), intensity, and spatial localization of the sound source. From the cochlea to the primary auditory cortex, the auditory fibers are organized anatomically in relation to the characteristic frequency of the sound signal that they transmit (tonotopy). Coding the intensity of the sound signal is based on temporal recruitment (the number of action potentials) and spatial recruitment (the number of inner hair cells recruited near the cell of the frequency that is characteristic of the stimulus). Because of binaural hearing, commissural pathways at each level of the auditory system and integration of the phase shift and the difference in intensity between signals coming from both ears, spatial localization of the sound source is possible. Finally, through the efferent fibers in the vestibular nerve, higher centers exercise control over the activity of the cochlea and adjust the peripheral hearing organ to external sound conditions, thus protecting the auditory system or increasing sensitivity by the attention given to the signal.     

Pneumomédiastin et emphysème sous-cutané du post-partum : une nouvelle observation

This case report refers to a 21-year-old primigravida, who complained of dyspnoea and was noticed to have unusual swelling of the face and neck after home delivery. A diagnosis of subcutaneous emphysema was made and this was confirmed with the chest X-ray. Pneumomediastinum and hydropneumothorax were also detected. Uneventful recovery over three days followed conservative management.     

Traitement du prolapsus genital par voie tranobturatrice : prolift

ObjectiveTo evaluate the efficacy, feasibility, and report the intraoperative and postoperative complications, and monitoring short-term treatment of prolapse bytransvaginal reinforcement type Prolift ®.Subjects and MethodsEleven women had a procedure for genital prolapse using the technique Prolift ® in Urology Hospital of Auxerre. Gyneco-obstetric characteristics, risk factors, previous treatments, interventions associated intraoperative and postoperative complications were noted. Patients are reviewed at one, three and six months and annually thereafter. Failure was defined by a recurrence greater than or equal to stage I of Baden and Walker classification.ResultsThe mean age was 70 years. The median follow up was 9 months. Two (18%) and nine (81%) patients had respectively cystocele grade II and III. Five (45%) hadrectocele of grade II /III. Three (27%) had hysterocele. The mean operating time was 40 minutes. Hospital stay was 3 days. No intraoperative complications were reported, three cases of postoperative cystitis, one (9%) treated by excision of vaginal erosion of the exposed portion, a stress urinary incontinence de novo (9%), two cases (18%) of urgenturie. The success rate was 90%.ConclusionThis study demonstrated the feasibility, short-term efficacy with acceptable morbidity of the technique of Prolift ® in the treatment of genital prolapse     

Tribloc (fémoral,sciatique, obturateur) pour la chirurgie ambulatoire arthroscopique de genou : étude prospective de faisabilité et d’efficacité

Background

The purpose of this study was to evaluate intra- and postoperative conditions of the triple nerve block technique (femoral, obturator, sciatic block) for outpatient knee arthrsopic procedures.

Methods

After written informed consent, ASA I-III patients received a combined triple nerve block with 30–40 ml lidocaine or mepivacaine (1,5%). Blocks were performed using a nerve stimulation technique. Onset time, block failure, supplemental general anesthesia (GA) or analgesia and pain score were recorded intraoperatively. After surgery, side effects (at days 0, 1, 3, 7 and after 4 weeks), patient and surgeon satisfactions were noted.

Results

Three hundred and twelve patients were screened and 115 triple blocks were performed (157 choosed GA, 19 spinal anaesthesia, 21 exclusion for regional anaesthesia). Failed blocks occurred for 12 (10%) patients. These 12 patients received GA before surgery incision. Time to complete block was 40 (10–60) min. Supplemental GA was required for 12 patients (12%) due to surgical (n = 7, 7%) or tourniquet (n = 5, 5%) pain. Intraoperative surgeon satisfaction was 90 (60–100). After surgery, time to discharge the postoperative care unit was 15 (5–60) min. Pain score at rest (Visual Analog Scale) until six hours was less than 30 /100, without any additionnal morphine. Two patients (< 2%) failed for ambulatory discharge criteria (no relation with triple block). At day 0, 3, 5% patients suffered PONV (8% at D1), paresthesia was noted in 1.7% at D0 (0,8% D3). No other secondary effects were observed after seven days and 91% patients “would like same anaesthesia” for next surgery.

Conclusion

We conclude that triple nerve block provided reliable intraoperative patient and surgical conditions for outpatient knee arthroscopy. Failed block (10%) was the major reason of supplemental anaesthesia. To increase surgical turn over under triple nerve block, a preoperative room may be required (block onset time).     

Méningite à streptocoque du groupe A : il n’y a pas que le pneumocoque qui s’infiltre dans la brèche ostéoméningée !

We reported a case of group A streptococcal meningitis in a patient with a CSF fluid leak. This case underlined several relevant points: (i) an unfrequent cause of bacterial meningitis; (ii) the main diagnosis to evoke when the direct examination of CSF shows Gram+ cocci with a negative pneumococcal antigen; (iii) that bacteria other than Streptococcus pneumoniae are possible in front of a meningitis associated with a CSF fluif leak.