Enquête sur les pratiques françaises d’analgésie en chirurgie thoracique (réalisée avec le concours de l’ARCOTHOVA)

Objective

To assess the current practice of analgesia after thoracotomy and thoracoscopy in France.

Study design

Cross-sectional practice survey.

Material

Anaesthetist physicians, each referent for one of the French centres practicing thoracic surgery, during year 2012.

Methods

Electronic questionnaire about the activity of the centre in thoracic surgery, and modalities and estimated frequencies of different analgesic techniques. Primary assessment was the estimated percentage of acts, after imputation from original data.

Results

Eighty-four centres out of 103 (82 %) answered the questionnaire. Coupling locoregional to general anaesthesia involved 74 % of thoracotomies and 35 % of thoracoscopies. A practice (i.e. for more than 5 % of patients) of epidural analgesia was declared by 68 centres (81 %), and by 27 centres (32 %) for paravertebral block. The most current practices for epidural analgesia were: thoracic puncture, intraoperative initiation, ropivacaïne 0.2 % plus sufentanil, patient-controlled administration with infusion plus bolus, application more than 48 hrs post surgery. The practice rates for technique of paravertebral block were: Eason & Wyatt 34 %, ultrasound-guided 24 %, internal 42 %. The most frequent systemic analgesia was patient-controlled intravenous morphine. Ketamine was used in 60 % of the cases.

Conclusions

French practice of analgesia after thoracic surgery improved quality during the last decade, but more than one patient on four (compared to 8 % in UK) may have neither epidural nor paravertebral block, while such techniques are nowadays considered as standard.