Les textes longs de la recommandation formalisée d’experts sur la prise en charge de la douleur postopératoire

Fletcher, Dominique; Aubrun, Frédéric

doi:10.1016/j.annfar.2008.12.001

Cited by 24 publications

(3 citation statements)

References 9 publications

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“…Sternotomy induces intense post-operative pain, mainly in the wound site and the shoulders 20. In this case, the post-operative analgesia is based on multimodal analgesia that can associate locoregional anaesthesia with systemic analgesics 3,4. The infusion of local anesthetic into the wound via a catheter inserted by the surgeon is a well-tolerated and straightforward procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Eljezi et al placed two catheters over the lateral edges of the sternum, thereby significantly reducing the pain experienced during mobilization 21. Expert recommendations in this regard include the insertion of a catheter in the presternal or mixed position (a retrosternal or a subcutaneous catheter) 4…”

Section: Discussionmentioning

confidence: 99%

“…Uncontrolled pain can have significant repercussions for a patient’s respiratory, cardiovascular, and cognitive function, in addition to increasing both the risk of morbidity and the length of the patient’s hospital stay 2. The guidelines recommend multimodal pain management that comprises locoregional and systemic analgesia 3,4. The continuous infusion of local anesthetic at the sternotomy site via a catheter inserted by the surgeon has been found be an effective technique associated with decreased post-operative pain and decreased morphine consumption 5–9…”

Section: Introductionmentioning

confidence: 99%

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<p>A single dose of tramadol in continuous wound analgesia with levobupivacaine does not reduce post-sternotomy pain: a randomized controlled trial</p>

Bethenod¹,

Ellouze²,

Berthoud³

et al. 2019

JPR

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BackgroundMedial sternotomy is commonly used in cardiac surgery, although it results in intense post-operative pain. The placement of a sternal wound catheter for the administration of local anesthetic represents an effective technique. An initial bolus of tramadol in the sternal wound catheter could potentiate the effect of the local anesthetic and decrease both the post-operative pain and the morphine consumption.Patients and methodsWe conducted a prospective, randomized, double-blind study at the University Hospital Center, Dijon, France. Patients requiring scheduled or non-extreme emergency surgery for valve disease, aorta disease, atrial myxoma, or coronary artery bypass graft via sternotomy were included. A sternal wound catheter was inserted at the end of the surgery. The patients were randomized to receive either a 2 mg/kg bolus of tramadol (n=80) or a placebo (n=80) in the wound catheter. The bolus administration was followed by a continuous infusion of 1.25% levobupivacaine for the first 48 hrs following surgery. The patients’ morphine consumption during the first 48 hrs after extubation was recorded. The other investigated variables were the patients’ rescue analgesia, arterial blood gasses, and length of stay in the intensive care unit and in hospital, as well as the incidence of chronic pain at the four-month follow-up point.ResultsThe morphine consumption was found to be comparable in the two groups (38 mg vs 32 mg, p=0.102). No effect was found in terms of the arterial blood gasses, lengths of stay, or incidence of chronic pain.ConclusionThe addition of tramadol to the local anesthetic delivered via a wound catheter following sternotomy did not reduce the patients’ post-operative morphine consumption.Trial registrationClinicaltrials.gov identifier: NCT02851394.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%