[Postoperative analgesia following trapeziectomy with continuous intra-articular infusion of ropivacaïne versus continuous perineural infusion. A prospective randomised study].
A prospective randomised study on 46 patients was performed to evaluate postoperative analgesia after trapezectomy. We compare the efficacy of an in situ catheter 777 (ISC) positioned by the surgeon in the space of the trapezectomy (26 patients) with an axilliary perineural catheter (APC) positioned preoperatively by the anaesthetist (20 patients). The patients were followed-up postoperatively for 48 hours and assessed at 3, 7, 24 and 48 hours, recording pain (VAS), consumption of intravenous rescue analgesia and recovery of sensory and motor function.


RESULTS
The mean time to site the ISC was 1 min 30 versus 16 min the APC group. The mean pain scores were: in the ISC group consistently below 2 for the entire postoperative 48 hours. Seven patients (29%) required supplemental analgesia (16 doses). Two patients failed (7.7%) to achieve adequate postoperative analgesia; they were the only patients in whom the surgeon had sited a drain, probably implying a siphoning off of the local anaesthetic solution. In the APC group also less than 2, and rescue analgesia was required by seven patients (35%) (40 doses). In four patients (20%) the pain score remained greater than 4 throughout the study period implying failure of the perineural catheter. There was a more rapid and complete recovery of both sensory and motor function in the group treated with in situ catheters during the study period. There were no haematomata or infections in the tow groups.


CONCLUSIONS
The in situ catheter provided at least as good postoperative analgesia while requiring considerably less time and expertise to site. There was also more rapid recovery of motor and sensory function in patients treated with in situ catheters.
Barbary
S
S
Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, hôpital Jeanne-d'Arc, CHU de Nancy, 54200 Dommartin-les-Toul, France. stephane.barbary@wanadoo.fr
O'Brien
J
J
Bouaziz
H
H
Mekler
G
G
Dap
F
F
Dautel
G
G
D000577:Amides / Q000008:administration & dosage*; D000698:Analgesia; D000779:Anesthetics, Local / Q000008:administration & dosage*; D006801:Humans; D007263:Infusions, Parenteral; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D000077212:Ropivacaine; D051222:Trapezium Bone / Q000601:surgery*
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine