Service d'Anesthésie-Réanimation, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Unité INSERM U987, Université Versailles Saint-Quentin, Versailles, France.
Service d'Anesthésie-Réanimation, Hôpital Ambroise Paré, Boulogne-Billancourt, France.
Anaesth Crit Care Pain Med. 2021 Feb;40(1):100790. doi: 10.1016/j.accpm.2020.100790. Epub 2020 Dec 5.
Multimodal analgesia, including a regional technique using perineural catheters (PNCs), is recommended for the treatment of moderate-to-severe acute postoperative pain. Perineural catheters are at risk of bacterial colonisation. In this study, we compared the cutaneous antiseptic efficacy of 2% alcoholic chlorhexidine and povidone-iodine-alcohol for preventing the bacterial colonisation of PNCs in orthopaedic surgery.
We performed a randomised, controlled trial, comparing two cutaneous antisepsis strategies, one based on 2% alcoholic chlorhexidine and the other on povidone-iodine-5% alcohol, for placed PNCs before orthopaedic surgery. The primary endpoint was the incidence of catheter bacterial colonisation (threshold > 1000 colony-forming units/ml). The secondary endpoints were the incidence of catheter-related infections and the adverse effects of the antiseptic solutions.
From November 2016 to May 2018, we included 113 patients in this study. The use of alcoholic chlorhexidine was associated with a lower incidence of catheter colonisation (15.5% (n = 9) versus 32.7% (n = 18); OR: 0.28 [0.09-0.77], p = 0.01). No catheter-related infections or adverse effects of antiseptic solutions were observed in either group. The risk factors associated with colonisation were a duration of catheter use ≥ 3 days (p = 0.04) and obesity (p = 0.005). The most frequently identified bacterium was Staphylococcus epidermidis.
Skin disinfection with 2% alcoholic chlorhexidine decreases bacterial colonisation rates for placed perineural catheters.
多模式镇痛，包括使用外周神经导管（PNC）的区域技术，被推荐用于治疗中重度急性术后疼痛。外周神经导管有细菌定植的风险。在这项研究中，我们比较了 2%酒精氯己定和聚维酮碘-酒精两种皮肤消毒剂在预防骨科手术中 PNC 细菌定植方面的效果。
我们进行了一项随机对照试验，比较了两种皮肤消毒策略，一种基于 2%酒精氯己定，另一种基于聚维酮碘-5%酒精，用于骨科手术前放置的 PNC。主要终点是导管细菌定植的发生率（阈值>1000 菌落形成单位/ml）。次要终点是导管相关感染的发生率和消毒剂的不良反应。
2016 年 11 月至 2018 年 5 月，我们共纳入 113 例患者。使用酒精氯己定与导管定植发生率较低相关（15.5%（n=9）与 32.7%（n=18）；OR：0.28 [0.09-0.77]，p=0.01）。两组均未观察到导管相关感染或消毒剂不良反应。与定植相关的危险因素是导管使用时间≥3 天（p=0.04）和肥胖（p=0.005）。最常鉴定的细菌是表皮葡萄球菌。
用 2%酒精氯己定消毒皮肤可降低放置的外周神经导管的细菌定植率。
