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Abstract: Introduction: The reduction of postoperative pain after surgery of inguinal hernia is an objective of lot of studies. The subfasciale infiltration of the wound may be an efficient technique. Methods: This study was designed as a randomized, double blind, prospective study, comparing two treatment groups: a group infiltrated by bupivacaine (Gr B), and second one infiltrated by a placebo (Gr P). A part of demographic parameters and ASA class, the postoperative pain intensity at rest and at coughing, the morphine consumption and the secondary effects were compared. Patient''s satisfaction and postoperative chronic pain at 3 and 6 months were also analyzed. Results: Concerning demographic parameters, ASA class and secondary effects, we didn’t find any meaningful difference between the two groups. However, there was a significant reduction of postoperative pain in the bupivacaine group as well at rest as coughing. Gr P patients have more morphine consumption and they were unsatisfied and accused more chronic pain. Discussion: Wound infiltration is still a simple and efficient technique in postoperative pain reduction. With this technique, hernia surgery may become ambulatory. [Copyright &y& Elsevier]

Abstract: A prospective randomised study on 46 patients was performed to evaluate postoperative analgesia after trapezectomy. We compare the efficacy of an in situ catheter 777 (ISC) positioned by the surgeon in the space of the trapezectomy (26 patients) with an axilliary perineural catheter (APC) positioned preoperatively by the anaesthetist (20 patients). The patients were followed-up postoperatively for 48hours and assessed at 3, 7, 24 and 48hours, recording pain (VAS), consumption of intravenous rescue analgesia and recovery of sensory and motor function. Results: The mean time to site the ISC was 1min30 versus 16min the APC group. The mean pain scores were: in the ISC group consistently below 2 for the entire postoperative 48hours. Seven patients (29%) required supplemental analgesia (16 doses). Two patients failed (7.7%) to achieve adequate postoperative analgesia; they were the only patients in whom the surgeon had sited a drain, probably implying a siphoning off of the local anaesthetic solution. In the APC group also less than 2, and rescue analgesia was required by seven patients (35%) (40 doses). In four patients (20%) the pain score remained greater than 4 throughout the study period implying failure of the perineural catheter. There was a more rapid and complete recovery of both sensory and motor function in the group treated with in situ catheters during the study period. There were no haematomata or infections in the tow groups. Conclusion: The in situ catheter provided at least as good postoperative analgesia while requiring considerably less time and expertise to site. There was also more rapid recovery of motor and sensory function in patients treated with in situ catheters. [Copyright &y& Elsevier]

Abstract: Objective: To determine the level of satisfaction in terms of pain relief and comfort among patients receiving different postoperative analgesia protocols after hand surgery under regional anaesthesia in a day care unit. Methods: Cohort study among patients after hand surgery under regional anaesthesia during two consecutive three months time periods, with patient stratification according to the expected pain level with different balanced analgesia protocols (group A: carpal tunnel, group B: other surgery without bone involvement, group C: bone surgery). A telephone survey, scoring analgesia and comfort, each with a numerical (0–10) scale was conducted on days 1 and 7. During the first period analgesia for groups A and B was the same (acetaminophen-dextropropoxyphene or acetaminophen-codein) and group C patients were treated with acetaminophen-ketoprofen-tramadol. In the second period analgesia was reduced for group A (acetaminophen alone) and increased for group B (acetaminophen-ketoprofen-tramadol) and group C (duration increased from 3 to 7 days). Results: For carpal tunnel surgery, analgesia with acetaminophen alone was efficient, (Pain scale [PS] d0=2[0–10], PS d1=1 [0–10] and PS d2–d4=0,5 [0–10]). This surgery does not elicit important pain, there is no benefit in adding other analgesics. For group B, a significant improvement in postoperative pain was observed (postoperative d1 p <0.03) with a major increase in side effects (2/57 vs 17/48 p <0.001). For group C, therapeutic changes were ineffective (PS d0=2 vs 3.5 et PS d1=3 vs 5 [NS]) and we noticed an increase in side effects (p <0.05). One third of all patients are totally satisfied on day 7, logistic regression showing the role of unefficient analgesia in late postoperative period (PS>2 between d2–d4). Between day 1 and day 7, 20% of the patients change their point of view, those who feel less satisfied on day 7 complained of a more severe postoperative pain between day 2 and 4 (p <0.001) and between day 5–7 (p <0.01). Conclusion: For hand surgery on day case, quality of late postoperative analgesia (day 2-day 7) is strongly related to patient''s satisfaction on day 7. [Copyright &y& Elsevier]

Abstract: Pain has to be treated during the perioperative period. The recent improvement in pain treatment results from a better understanding of pain mechanisms, strict evaluations and appropriate protocols for pain management. Mainly nociceptive, postoperative pain looks more and more like neuropathic pain when it persists or increases. Therefore, analgesics are no more effective and antihyperalgesiant drugs must use. Preventive treatments have to be considered first as the best pain treatment. Basically, perioperative pain has to be understood as a standard quality management by the medical and surgical team. [Copyright &y& Elsevier]

Résumé: Nous rapportons le cas de quatre patientes opérées de chirurgie sénologique et chez lesquelles l’analgésie postopératoire a été réalisée par perfusion continue de lévobupivacaïne à l’aide d’un cathéter placé sous échographie dans l’espace interpectoral. L’analgésie postopératoire était excellente et aucun effet secondaire n’a été relevé. [ABSTRACT FROM AUTHOR]

Abstract: Currently, day-case surgery has a significant development. In pediatrics, a big part of interventions can be performed as a day-case surgery. However, postoperative pain, often wrongly regarded as minor, should not be underestimated or undertreated. The aim of this paper is to review the available systemic analgesics and to propose a way to use them in order to improve children''s comfort and experiences in their own families. [Copyright &y& Elsevier]