Pourtales M-C, Kuntzmann H, Bertrand F, Pottecher T, Gouzou S, Liverneaux P
Département d'anesthésie-réanimation, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, Strasbourg, France.
Chir Main. 2010 Apr;29(2):82-7. doi: 10.1016/j.main.2010.01.002. Epub 2010 Feb 23.
In hand surgery, ever since continuous at-home postoperative analgesia (CPA) was implemented, procedures which cause pain for more than 24h can now be performed in ambulatory surgery. The aim of our work was to study the feasibility of CPA. Our series comprised 40 patients with a mean age of 50 years. Twenty-four patients had an ASA score of 1 and 16 patients had an ASA score of 2. Indications were osteoarthritis and rheumatoid diseases. Three steps were involved: preoperative (patient screening and information), peroperative (placement of a peripheral nerve catheter through an axillary approach using an elastomeric device) and postoperative (at-home patient care provided by visiting nurses). Evaluation was rated using a CPA score (0 to 10) based on analgesia quality and network organization data. The global CPA score was 1.85. The quality of analgesia (2.6) scored less than the quality of organization (1.1). In the case of analgesia, sleep obtained the lowest score, followed by pain, and lastly, unwanted events. As far as organization was concerned, the network obtained the lowest score, followed by patient satisfaction, and lastly, patient information. Problems were encountered due to insufficient nurse training, analgesia failures, as well as unwanted events related to the oral antalgic treatment. However, technical success was almost always achieved. Our results show that the indications for ambulatory surgery could be extended and hospital-private practice networks be further developed. CPA appears to be a promising technique for analgesia and ambulatory surgery.
在手外科领域，自从实施持续术后家庭镇痛（CPA）以来，现在可以在门诊手术中开展那些会导致疼痛超过24小时的手术。我们这项工作的目的是研究CPA的可行性。我们的研究系列包括40例患者，平均年龄为50岁。24例患者的美国麻醉医师协会（ASA）评分为1分，16例患者的ASA评分为2分。手术指征为骨关节炎和类风湿疾病。该过程包括三个阶段：术前（患者筛查和信息告知）、术中（通过腋窝入路使用弹性装置放置外周神经导管）和术后（由访视护士提供家庭患者护理）。基于镇痛质量和网络组织数据，使用CPA评分（0至10分）进行评估。总体CPA评分为1.85分。镇痛质量（2.6分）低于组织质量（1.1分）。在镇痛方面，睡眠得分最低，其次是疼痛，最后是不良事件。就组织方面而言，网络得分最低，其次是患者满意度，最后是患者信息。由于护士培训不足、镇痛失败以及与口服镇痛药治疗相关的不良事件而遇到了问题。然而，几乎总能取得技术上的成功。我们的结果表明，门诊手术的指征可以扩大，医院-私人执业网络可以进一步发展。CPA似乎是一种有前景的镇痛和门诊手术技术。
