Beaussier M, Bouaziz H, Aubrun F, Belbachir A, Binhas M, Bloc S, Fuzier R, Jochum D, Nouette-Gaulain K, Paqueron X
Département d'anesthésie-réanimation chirurgicale, hôpital Saint-Antoine, université Pierre-et-Marie-Curie, Paris-6, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France.
Ann Fr Anesth Reanim. 2012 Feb;31(2):120-5. doi: 10.1016/j.annfar.2011.10.017. Epub 2011 Dec 29.
Local wound infiltration is a component of multimodal postoperative (p.o.) analgesia. Its implementation in current clinical practice remains unknown. Pain and Regional Anesthesia Committee of the French Anaesthesia and Intensive Care Society (Sfar) aimed to appraise its practice.
Postal sample survey based on representative sample of national activity were sent to heads of anaesthesiology departments. The questionnaires included 36 items on single-shot and continuous wound infiltrations (CWI) with considerations about modality of administration, drugs and development limitations. Results in mean [CI95 %].
Response rate was 32 % (n=120). Sample was in accordance with national representation of health institutions. Local infiltration was included in 85 % [79-91] of the p.o. analgesia protocols. Regardless of the surgery, single-shot wound infiltration and CWI were used in more than 50 % of the patients by respectively 58 % [49-67] and 18 % [11-25] of the responders. However, a significant part of the surgeons remained reluctant to CWI. Lack of information and fear of septic complications were the most reported barriers. Peritoneal instillation after laparoscopy was rarely performed, in contrast with intra-articular infiltration after knee arthroscopy, performed systematically or very frequently by 60 % [50-70] of the responders.
The practice of local wound infiltration for p.o. analgesia seems presently well established, especially for single-shot injections. CWI is less commonly performed. Several surgical reluctances remain to be overcome. Better information about effectiveness and safety are likely to still improve their practices.
局部伤口浸润是多模式术后镇痛的组成部分。其在当前临床实践中的应用情况尚不清楚。法国麻醉与重症监护学会（Sfar）疼痛与区域麻醉委员会旨在评估其应用情况。
基于全国活动的代表性样本进行邮政抽样调查，问卷发送给麻醉科主任。问卷包含36项关于单次和持续伤口浸润（CWI）的内容，涉及给药方式、药物及发展局限性等方面。结果以均值[CI95%]表示。
回复率为32%（n = 120）。样本与卫生机构的全国代表性相符。85%[79 - 91]的术后镇痛方案包含局部浸润。无论何种手术，超过50%的患者接受了单次伤口浸润和CWI，分别有58%[49 - 67]和18%[11 - 25]的受访者采用。然而，相当一部分外科医生对CWI仍持抵触态度。信息不足和担心感染并发症是最常提及的障碍。腹腔镜检查后的腹腔内灌注很少进行，与之形成对比的是，膝关节镜检查后的关节内浸润，60%[50 - 70]的受访者系统地或非常频繁地进行。
目前，局部伤口浸润用于术后镇痛的做法似乎已得到广泛确立，尤其是单次注射。CWI的应用较少。仍有一些外科方面的抵触需要克服。关于有效性和安全性的更多信息可能仍会改善他们的做法。
