Efficacité de l’infiltration cicatricielle subfasciale par la bupivacaïne dans la réduction de la douleur postopératoire des hernies inguinales

Introduction

The reduction of postoperative pain after surgery of inguinal hernia is an objective of lot of studies. The subfasciale infiltration of the wound may be an efficient technique.

Methods

This study was designed as a randomized, double blind, prospective study, comparing two treatment groups: a group infiltrated by bupivacaine (Gr B), and second one infiltrated by a placebo (Gr P). A part of demographic parameters and ASA class, the postoperative pain intensity at rest and at coughing, the morphine consumption and the secondary effects were compared. Patient's satisfaction and postoperative chronic pain at 3 and 6 months were also analyzed.

Results

Concerning demographic parameters, ASA class and secondary effects, we didn’t find any meaningful difference between the two groups. However, there was a significant reduction of postoperative pain in the bupivacaine group as well at rest as coughing. Gr P patients have more morphine consumption and they were unsatisfied and accused more chronic pain.

Discussion

Wound infiltration is still a simple and efficient technique in postoperative pain reduction. With this technique, hernia surgery may become ambulatory.     

Radiothérapie des glioblastomes de l’adulte

Radiation therapy is a treatment of malignant gliomas in adults. It improves survival rates, whether used alone, in addition to surgery, or in combination with chemotherapy. Three-dimensional imaging techniques, image fusion, and conformational radiotherapy are optimizing treatment plans for the treatment of these tumors and are sparing healthy tissue. After a review of the physical and biological bases of ionizing radiation, we present the techniques, results, side effects, and results of irradiation of glioblastomas.     

Élargissement des plages horaires de visites dans une unité de réanimation : l’avis des proches

Objective

The present study was aimed at assessing the opinion of the patient's relatives concerning the visiting hours in the ICU.

Method

The visiting relatives were questioned about the information delivered in the Unit (assessed as 0 for minimal and 10 for maximal assessments, respectively) and the hypothesis to extend the Unit's visiting hours. The responses were given independently by the relatives.

Results

Eighty-seven out of 64 relatives responded (63% females). The delivered information was assessed by a median note = 10 (interquartile: [8–10]). The current visiting times (2 h per day during the week, 6 h in weekend) were assessed as sufficient by 48 closest (58%). Fifty-four (67%, CI95% = [56–77]) requested more liberal visiting times and 38 (46%, CI95% = [36–57]) requested 24 h visiting policy. Five relatives (6%, CI95% = [1–11]) would like to be present during patient's care. Most relatives do not wish to assist to patient's care to avoid interfering with caregiver's workload (81%), to respect the patient's intimacy (49%) and by fear of being impressed by the care (23%). Forty percent of the relatives would like to help feeding the patient.

Conclusion

Most of the relatives wish for more liberal visiting times without interfering with patient's care.