Introduction
The regional anesthesia is experiencing a big boom in the daily practice of intensive care anesthetists. The major interest of peripheral nerve blocks in emergencies lies in the absence of general repercussion [1], facilitating perioperative [2] with a better predictor of patient satisfaction and a major economic impact [3-4]. This technique can be an interesting alternative to general anesthesia and anesthesia perimedullary (APM) as part of the emergency, when they would be at risk [1,5,6] Within our training about 35% of surgical emergencies are performed under local anesthesia with approximately 90% of emergency concerning the members are performed under regional anesthesia device. We report through this study the experience of anesthesia pole and reanimation- emergencies involving the provision of ALR in the operating room when the emergency AG and / or epidural ALR can be dangerous.
Materials and Methods
This is a prospective study conducted in the operating room for emergencies Military Hospital Moulay Ismail in Meknes on a oneyear period extending from January 2016 to January 2017. Were included patients admitted for surgical emergencies and members with serious violations of cardiorespiratory and metabolic functions and for whom general anesthesia or spinal perished were deemed at risk where ALR device would be a good alternative. Exclusion criteria were patient refusal, allergy to local anesthetics, severe coagulation abnormalities. Peripheral nerve blocks were performed under standard monitoring, post-interventional surveillance room or neurostimulation or ultrasound guidance using local anesthetics like lidocaine 1% and 0.25% bupivacaine. The effectiveness of the block was assessed prior to admission of the patient to the operating room, in case of failure or insufficient block additional block was conducted Were assessed hemodynamics, respiratory, neurological, analgesia and patient satisfaction in per and postoperative.
Results
Our study includes 30 patients, including 18 men and 12 women with a sex ratio of 1.5 M / F, mean age 72.5 years (63-82). The evaluation of our patients pre anesthetic has classified all ASA III and IV (Table 1) with 4 presented difficult intubation criteria and 7 ventilation criteria difficult mask. 20 blocks were made to the lower limbs and 10 graduate members. The ultrasonographic guidance was conducted in sixteen cases and fourteen neurostimulation (Table 2). Local anesthetics used were 1% lidocaine and bupivacaine 0.25%, the volumes used ranged from 20 to 40ml.
The number of requested specialized medical opinion in all our patients were limited to 4. The transthoracic echocardiography was not sought in any of our patients and the time interval between hospital admission and surgery was reduced by half in comparison with IV or ASA III patients who were operated on under general anesthesia or spinal anesthesia during the same period. The monitoring was standard in all cases, interventions were conducted without repercussion on the previous state of patients. Intraoperatively, changes in the FC were 6% (3-10%), blood pressure was 5% (2-8%) with respect to the intake values, the filling was provided by the saline with volumes ranging from 250 to 500cc and no patient needed vasoactive agents. No cases of respiratory distress, confusion or agitation in intraoperative or postoperative had been noted and none of our patients had need to stay in the intensive care unit after surgery.
In post-operative, all patients had a good quality of analgesia 6.5 (3-10) hours. At the rising of sensory block, VAS pain was estimated at 1 and calmed by paracetamol 1g infusion. After the 8th time, our patients had a mean VAS between 2 and 3, under control by paracetamol infusion and nefopam, only 2 patients required morphine iv 5mg and 5mg sc. The next day, our patients had a VAS pain˂3 and benefit of analgesia alone or paracetamol associated with codeine. Approximately 40% of patients expressed their discomfort with the realization of the block, but postoperative they were satisfied with the quality of algesia and no vomiting nausea. The anesthetic team was satisfied with fewer interventions in the operating room and even the bathroom SSPI. The stay in recovery room averaged 30 minutes, allowing patients to quickly join their relatives with less stress monitoring devices and a number of great satisfactions. The incidents were noticed a feeling of discomfort when performing in 12 patients, a vagal malaise and arrhythmia in three patients, and associated additives were further block in 02 patients and a supplement sedation in 02 case.
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