[Analgesia using continuous axillary block after surgery of severe hand injuries: self-administration versus continuous injection].
OBJECTIVE
To compare analgesia produced after surgery for severe hand trauma, by a continuous axillary block obtained either with a continuous injection (CA) or controlled by the patient (PCA).


METHODS
Prospective, randomized study.


METHODS
Forty-two ASA physical class 1 and 2 patients were enrolled over a twelve-month period and randomly allocated either into the CA or the PCA group.


METHODS
After recovery from the surgical block, the axillary plexus was located using a nerve stimulator and a 20 G catheter (Contiplex B Braun) inserted over 5 centimeters into the axillary sheath. In the CA group (n = 21) patients received 0.1 mL.kg-1.h-1 of 0.25% bupivacaine and in the PCA group (n = 21) patients received 0.1 mL.kg-1 boluses of 0.25% bupivacaine with a one hour lock-out period. Data collected were pain intensity rated according to he visual analog scale (VAS), the total volume of bupivacaine injected, the quantity of nalbuphine administered as 10 mg boluses when VAS was = 5, and the patient's satisfaction after removal of the catheter. Statistical analysis used Student t test, ANOVA and chi 2 test.


RESULTS
The mean duration of catheter use was 5 +/- 3 days. During this period the amount of bupivacaine was significantly reduced in the PCA group when compared to the CA group (P < 0.001). Similarly, the PCA group required significantly less nalbuphine. Finally, in this group, the satisfaction index was higher than in the CA group (95 versus 52% respectively, P < 0.01).


CONCLUSIONS
Continuous axillary plexus blockade provides safe and effective postoperative analgesia. With the PCA technique results a lower quantity of bupivacaine is required and patient's satisfaction better.
Iskandar
H
H
Département d'anesthésie-réanimation, CHU Pellegrin, Bordeaux, France.
Rakotondriamihary
S
S
Dixmérias
F
F
Binje
B
B
Maurette
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods*; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D001365:Axilla / Q000294:innervation*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005260:Female; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009266:Nalbuphine / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D017060:Patient Satisfaction; D011446:Prospective Studies
D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009266:Nalbuphine; D002045:Bupivacaine
Analgésie par bloc axillaire continu après chirurgie des traumatismes graves de la main: auto-administration versus injection continue.