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Abstract
ABSTRACT
Introduction. Echo guidance improves patient safety in locoregional anesthesia (LRA). Objective. To evaluate the practice of ultrasound-guided blocks in adults in Malian adults. Patients and Methods. Our prospective cross-sectional observational study was conducted in the anesthesia-intensive care unit, orthopedic traumatology, and thoracic and cardiovascular surgery departments of Hopital du Mali (Bamako) from August 2022 to January 2023 (six months). Results During the study period, 30 patients met our criteria (2.2%). The sex ratio was 5. The mean age was 40.8 ± 18.5 years. Most patients came from the orthopedic traumatology department (90%) and had scheduled surgeries (60%). The ASA score was mostly ASA I (66.7%). Pharmacological premedication was done in 23.3% of patients. Axillary block was performed in 53.3% of cases. Bupivacaine was the most commonly used drug, with dexamethasone as an adjuvant in 30% of cases. The mean anesthetic volume was 21.2 ± 2.8 mL, with a delivery time of 9.5 ± 3.55 minutes and an installation time of 11.5 ± 6.3 minutes. The combination of bupivacaine and lidocaine led to a faster installation. An accident occurred in 3.3% of cases. Surgery lasted 58.4 ± 31.5 minutes and the sensory block duration was 271.07 ± 107.98 minutes. Postoperatively, morphine sparing was possible in 93.4% of patients with reduced hospital stay and high satisfaction in 86.7% of cases. Conclusion. Ultrasound-guided LRA should bepromoted, particularly in ambulatory limb surgery.
RÉSUMÉ
Introduction. Le guidage échographique améliore la sécurité des patients lors de l'anesthésie locorégionale (ALR). Objectif. Évaluer la pratique des blocs échoguidés chez l'adulte au Mali. Patients et méthodes. Notre étude observationnelle transversale prospective a été menée dans les services d'anesthésie-réanimation, de traumatologie orthopédique et de chirurgie thoracique et cardiovasculaire de l'hôpital du Mali (Bamako) d'août 2022 à janvier 2023 (six mois). Résultats Durant la période d'étude, 30 patients répondaient à nos critères (2,2 %). Le sex-ratio était de 5. L'âge moyen était de 40,8 ± 18,5 ans. La plupart des patients provenaient du service de traumatologie orthopédique (90%) et avaient des chirurgies programmées (60%). Le score ASA était principalement ASA I (66,7 %). Une prémédication pharmacologique a été réalisée chez 23,3 % des patients. Un bloc axillaire a été réalisé dans 53,3 % des cas. La bupivacaïne était le médicament le plus couramment utilisé, avec la dexaméthasone comme adjuvant dans 30 % des cas. Le volume anesthésique moyen était de 21,2 ± 2,8 ml, avec un temps d'administration de 9,5 ± 3,55 minutes et un temps d'installation de 11,5 ± 6,3 minutes. La combinaison de bupivacaïne et de lidocaïne a permis une pose plus rapide. Un accident est survenu dans 3,3 % des cas. L'intervention chirurgicale a duré 58,4 ± 31,5 minutes et la durée du bloc sensoriel a été de 271,07 ± 107,98 minutes. En postopératoire, l'épargne morphinique a été possible chez 93,4 % des patients avec une durée d'hospitalisation réduite et une grande satisfaction dans 86,7 % des cas. Conclusion. L'ARS guidée par ultrasons devrait être promue, en particulier dans la chirurgie ambulatoire des membres.
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References
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- -Namba RS, Kabo JM, Dorey FJ, Meals RA. Continuous passive motion versus immobilization. The effect on posttraumatic joint stiffness. Clin Orthop Relat Res 1991:218-23.
- -Freysz M, Ricard-Hibon A, Adnet F, Auroy Y, Averland B, Bouaziz H et al. Practice of local and locoregional anaesthesia by doctors who are not specialized in anaesthesia and intensive care, in the context of emergencies. Ann Fr Anesth Reanim 2004; 23:167-76.
- - Hadzic A, Williams BA, Karaca PE, Hobeika P, Unis G, Dermksian J, et al. For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia. Anesthesiology 2005; 102:1001–7.
- - Wu CL, Rowlingson AJ, Partin AW, Kalish MA, Courpas GE, Walsh PC, Fleisher LA. Correlation of postoperative pain to quality of recovery in the immediate postoperative period. Reg Anesth Pain Med 2005; 30:516-22.
- - Mardaye A, Aegerter P, Fermanian C, Ecoffey C, Fletcher D. Evaluation of postoperative analgesia practices: a national survey. 49th National Congress of Anesthesia and Resuscitation SFAR, Elsevier Paris 2007: 715-738.
- - Beye MD, Ndiaye PI, Ndoye Diop M, Diouf E, Fall L, Leye PA, Sall Ka B. Evaluation of the practice of peripheral locoregional anesthesia in the emergency room of the Aristide Le Dantec Hospital in Dakar. Rev. Afr. Anesth. Med. Urg. 2007; 12: 27-37.
- - Diarrah B. M. Peripheral locoregional anaesthesia in Africa: what perspectives? African Journal of Anesthesiology and Emergency Medicine 2011; 16 (3).
- -Afane Ela A, Ngouatna S. R, G. Ngayap Guemnaing, Esiene A, Owono Etoundi P. Perioperative Analgesia by Peripheral Nerve Blocks of the Limbs at the Central Hospital of Yaoundé. Health Sci. Dis. 2014; 15 (1) :1-9.
- - Donamou J, Bah ML, Bangoura A. Loco-regional anesthesia in a country with limited resources: lidocaine 1.5% adrenalin, alternative to ropivacaine 0.5% for ultrasound-guided axillary block Med. Too much and international health; 2021; (5118): 1-5.
- - Leye PA, Traoré MM, Bah MD, Ndiaye PI, Fall ML, Diop MN et al. Evaluation of the practice of ultrasound-guided axillary block at the Aristide Le Dantec University Hospital in Dakar. Rev Afr Anesthesiol Med Urg .2017; 22 (1) :53-57.
- -Bula-Bula IM, Kamanda R, Mukuna P, Lepira F, Mbuyi M, Babakazo D Et al. Critical reading of the ASA status score: analysis of a survey conducted during a SARANF congress. Rev Afr Anesthesiol Med Urg. 2016; 21(2) :47-50.
- - Eledjam JJ, Viel E, Coudane H, Dalens B, Daures JP, Dupré LJ et al. Peripheral limb blocks in adults. Ann Fr Anesth Reanim. 2003; 22: 567–581.
- -Cuvillon P, Zoric L, Ripart J. How do I manage the duration of a block (dose, concentration, catheter)? Focus in anaesthesia and intensive care 2011: 83-92.
- - Beye S. A, Ndiaye PI, Naouiani L, Leye PA, Diouf E, Ka Sall B. Evaluation of the block at the humeral canal. Rev Afr Anesthesiol Med Urg. 2011; 16 (1).
- - Owono Etoundi P, Afané Ela A, Ngayap G, Handy Eone D, Binam F. Plexic block in humeral osteosynthesis: effects of buprenorphine combined with local anesthetics in postoperative analgesia. Orthopaedica emergencia africa 2012; 1 (2): 29-31.
- - Gaertner E. Analgesia by peripheral block: bolus, continuous or PCA? Clarification in anaesthesia and intensive care 2000: 327-335.
- - Beloeil H, Marret E. What is the benefit of using non-morphine analgesics? 51st National Convention; SFAR, Paris 2009.
- - Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d'Athis F. "Effects of Perioperative Analgesic Techniques on the Surgical Outcome and Duration of Rehabilitation after Major Knee Surgery," Anesthesiology, 1999; 91 (1) :8-15.
- Capdevila X, Ponrouch M. What are the benefits of peripheral blocks outside of analgesia? SFAR, Elsevier Paris 2008 : 751-757.
References
- Choquet O, Capdevila X. Peripheral nerve blocks. In; Traité d'Anesthésie et de Réanimation 4th ed. Olivier Fourcade, Thomas Geeraerts, Vincent Minville, Kamran Samii, Paris: Lavoisier; 2014 :284-311.
- Ullah H, Samad K, Khan FA. Continuous interscalene brachial plexus block versus parenteral analgesia for postoperative pain relief after major shoulder surgery. Cochrane Database Syst Rev 2014; 2:CD007080.
-Namba RS, Kabo JM, Dorey FJ, Meals RA. Continuous passive motion versus immobilization. The effect on posttraumatic joint stiffness. Clin Orthop Relat Res 1991:218-23.
-Freysz M, Ricard-Hibon A, Adnet F, Auroy Y, Averland B, Bouaziz H et al. Practice of local and locoregional anaesthesia by doctors who are not specialized in anaesthesia and intensive care, in the context of emergencies. Ann Fr Anesth Reanim 2004; 23:167-76.
- Hadzic A, Williams BA, Karaca PE, Hobeika P, Unis G, Dermksian J, et al. For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia. Anesthesiology 2005; 102:1001–7.
- Wu CL, Rowlingson AJ, Partin AW, Kalish MA, Courpas GE, Walsh PC, Fleisher LA. Correlation of postoperative pain to quality of recovery in the immediate postoperative period. Reg Anesth Pain Med 2005; 30:516-22.
- Mardaye A, Aegerter P, Fermanian C, Ecoffey C, Fletcher D. Evaluation of postoperative analgesia practices: a national survey. 49th National Congress of Anesthesia and Resuscitation SFAR, Elsevier Paris 2007: 715-738.
- Beye MD, Ndiaye PI, Ndoye Diop M, Diouf E, Fall L, Leye PA, Sall Ka B. Evaluation of the practice of peripheral locoregional anesthesia in the emergency room of the Aristide Le Dantec Hospital in Dakar. Rev. Afr. Anesth. Med. Urg. 2007; 12: 27-37.
- Diarrah B. M. Peripheral locoregional anaesthesia in Africa: what perspectives? African Journal of Anesthesiology and Emergency Medicine 2011; 16 (3).
-Afane Ela A, Ngouatna S. R, G. Ngayap Guemnaing, Esiene A, Owono Etoundi P. Perioperative Analgesia by Peripheral Nerve Blocks of the Limbs at the Central Hospital of Yaoundé. Health Sci. Dis. 2014; 15 (1) :1-9.
- Donamou J, Bah ML, Bangoura A. Loco-regional anesthesia in a country with limited resources: lidocaine 1.5% adrenalin, alternative to ropivacaine 0.5% for ultrasound-guided axillary block Med. Too much and international health; 2021; (5118): 1-5.
- Leye PA, Traoré MM, Bah MD, Ndiaye PI, Fall ML, Diop MN et al. Evaluation of the practice of ultrasound-guided axillary block at the Aristide Le Dantec University Hospital in Dakar. Rev Afr Anesthesiol Med Urg .2017; 22 (1) :53-57.
-Bula-Bula IM, Kamanda R, Mukuna P, Lepira F, Mbuyi M, Babakazo D Et al. Critical reading of the ASA status score: analysis of a survey conducted during a SARANF congress. Rev Afr Anesthesiol Med Urg. 2016; 21(2) :47-50.
- Eledjam JJ, Viel E, Coudane H, Dalens B, Daures JP, Dupré LJ et al. Peripheral limb blocks in adults. Ann Fr Anesth Reanim. 2003; 22: 567–581.
-Cuvillon P, Zoric L, Ripart J. How do I manage the duration of a block (dose, concentration, catheter)? Focus in anaesthesia and intensive care 2011: 83-92.
- Beye S. A, Ndiaye PI, Naouiani L, Leye PA, Diouf E, Ka Sall B. Evaluation of the block at the humeral canal. Rev Afr Anesthesiol Med Urg. 2011; 16 (1).
- Owono Etoundi P, Afané Ela A, Ngayap G, Handy Eone D, Binam F. Plexic block in humeral osteosynthesis: effects of buprenorphine combined with local anesthetics in postoperative analgesia. Orthopaedica emergencia africa 2012; 1 (2): 29-31.
- Gaertner E. Analgesia by peripheral block: bolus, continuous or PCA? Clarification in anaesthesia and intensive care 2000: 327-335.
- Beloeil H, Marret E. What is the benefit of using non-morphine analgesics? 51st National Convention; SFAR, Paris 2009.
- Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d'Athis F. "Effects of Perioperative Analgesic Techniques on the Surgical Outcome and Duration of Rehabilitation after Major Knee Surgery," Anesthesiology, 1999; 91 (1) :8-15.
Capdevila X, Ponrouch M. What are the benefits of peripheral blocks outside of analgesia? SFAR, Elsevier Paris 2008 : 751-757.