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Alain Borgeat

Publications and source records attributed to Alain Borgeat.

At least 19 recordsLinked to original sources
PubMed2006

Postoperative analgesia after anterior correction of thoracic scoliosis: a prospective randomized study comparing continuous double epidural catheter technique with intravenous morphine.

STUDY DESIGN: Prospective randomized comparative study of two techniques for postoperative analgesia. OBJECTIVE: Assess the efficacy of two epidural catheters compared with intravenous morphine after anterior correction of thoracic scoliosis. SUMMARY OF BACKGROUND DATA: Spine surgery with anterior thoracotomy can cause severe postoperative pain. Continuous epidural analgesia through two epidural catheters was shown to be effective after posterior scoliosis correction. The efficacy of this technique has still not been demonstrated in this surgical context. METHODS: Thirty adolescent patients with thoracic idiopathic scoliosis scheduled for anterior correction were prospectively randomized into morphine (M) or epidural (E) group. In the E group, two epidural catheters were placed transforaminally after scoliosis correction. The immediate postoperative analgesia was performed with remifentanil in all patients until the first postoperative morning (T0 = begin of study), when either continuous intravenous morphine (M group) or continuous epidural ropivacaine 0.3% (E group) was initiated. Pain at rest and in motion, morphine consumption, sensory level, motor blockade, nausea/vomiting, pruritus, bowel function, and patient satisfaction were assessed. RESULTS: In the E group, there was significantly less pain at rest and in motion, less rescue morphine consumption, improved bowel activity, and higher patient satisfaction. The incidence of side effects was significantly higher in M group. CONCLUSIONS: Two epidural catheters provide better postoperative analgesia with fewer side effects and higher patient satisfaction after anterior instrumentation of thoracic scoliosis.

Adolescent↗
PubMed2006

Ropivacaine decreases inflammation in experimental endotoxin-induced lung injury.

BACKGROUND: Endotoxin causes acute lung injury, which can lead to acute respiratory distress syndrome. Because local anesthetics are known to attenuate inflammatory reactions, ropivacaine was tested for its possible antiinflammatory effect in lipopolysaccharide-induced lung injury in rat alveolar epithelial cells (AECs) and rat pulmonary artery endothelial cells (RPAECs) in vitro and in vivo. METHODS: AECs and RPAECs were stimulated for 4 h with lipopolysaccharide or lipopolysaccharide and 1 mum ropivacaine. Messenger RNA (mRNA) for intercellular adhesion molecule 1 was assessed. Isolated neutrophils were incubated with stimulated target cells to quantify adhesion and neutrophil-induced cytotoxicity in AECs and RPAECs. In vivo, lipopolysaccharide was instilled intratracheally with or without 1 mm intratracheally or intravenously administered ropivacaine. Bronchoalveolar lavage was performed 5 h later to determine neutrophil and albumin content, as well as concentrations of inflammatory mediators. RESULTS: In AECs and RPAECs, ropivacaine attenuated lipopolysaccharide-induced up-regulation of mRNA for intercellular adhesion molecule 1 by 41% and 24%, respectively (P < 0.05). In the presence of ropivacaine, increased neutrophil adhesion was down-regulated by 58% and 44% (P < 0.005), whereas cytotoxicity in AECs and RPAECs was diminished by 28% and 33%, respectively (P < 0.05). Enhanced neutrophil count in lipopolysaccharide lungs was reduced by 56% in the presence of intratracheally instilled ropivacaine (81% with intravenous ropivacaine; P < 0.005). Albumin was decreased by 46% with intratracheal ropivacaine (38% with intravenous ropivacaine; P < 0.05), and inflammatory mediators were decreased by 48-59% (69-81% with intravenous ropivacaine; P < 0.01). CONCLUSIONS: Ropivacaine intervention substantially attenuated the inflammatory response in acute lung injury and thus may carry an interesting potential for antiinflammatory treatment.

Adult↗
PubMed2006

The feasibility and complications of the continuous popliteal nerve block: a 1001-case survey.

Perineural catheters are increasingly used worldwide for the treatment of postoperative pain in orthopedics. Long-term complications associated with the placement of a perineural catheter remain largely unstudied. We investigated the efficacy and the acute and late complications associated with the continuous popliteal nerve block. One-thousand-one patients undergoing elective surgery of the ankle or foot and scheduled to have a continuous popliteal nerve block were prospectively evaluated. All patients received an initial bolus of 40 mL ropivacaine 0.5% through the catheter. A continuous infusion of ropivacaine 0.3% initiated 6 h after the initial bolus was administered for the first 24 h and then decreased to ropivacaine 0.2% until the end of the study period. The success rate and acute complications were recorded. The overall success rate was 97.5%. The highest success rate was associated with foot inversion. Acute complications consisted of paresthesias during nerve localization (0.5%), pain during local anesthetic application (0.8%), and blood aspiration (0.4%). No central nervous system toxicity or cardiotoxicity occurred. Late complications were checked at 10 days and 3 mo after surgery. These included two cases of inflammation at the puncture site. No infection or neuropathy was observed. The use of continuous popliteal nerve block for ankle or foot surgery is associated with frequent success and few acute and late complications.

Adult↗
PubMed2005

Double epidural catheter with ropivacaine versus intravenous morphine: a comparison for postoperative analgesia after scoliosis correction surgery.

BACKGROUND: Major spine surgery with a dorsal or ventrodorsal approach causes severe postoperative pain. The use of continuous epidural analgesia through one or two epidural catheters placed intraoperatively by the surgeon has been shown to provide efficient postoperative pain control. In this prospective unblinded study, the authors compared the efficacy of continuous intravenous morphine with a continuous double epidural catheter technique with ropivacaine after scoliosis correction. METHODS: Thirty patients with American Society of Anesthesiology physical status I-III were prospectively randomized to either the morphine group or the epidural group. At the end of surgery, patients in the epidural group received two epidural catheters placed by the surgeon, one directed cephalad and one caudally. Correct placement was checked radiographically. Postoperative analgesia until the first postoperative morning was performed with remifentanil target-control infusion for all patients. From that time remifentanil was stopped and continuous intravenous analgesia with morphine or double epidural analgesia with ropivacaine 0.3% was initiated (T0 = beginning of study). Pain at rest and pain in motion (using a visual analog scale from 0-100), the amount of rescue analgesics, sensory level, motor blockade, postoperative nausea and vomiting, and pruritus were assessed every 6 h and bowel function was assessed every 12 h until T72 (end of study). Two days later, patient satisfaction was assessed. RESULTS: Pain scores at rest were significantly decreased in the epidural group at all time points except at T12, T60, and T72. Pain scores in motion were significantly decreased in the epidural group at T24, T48, and T72. Bowel activity was significantly better in the epidural group at T24, T36, T48, and T60. Postoperative nausea and vomiting and pruritus occurred significantly less frequently in the epidural group. No complications related to the epidural catheter occurred. CONCLUSIONS: Both methods provide efficient postoperative analgesia. However, double epidural catheter technique provides better postoperative analgesia, earlier recovery of bowel function, fewer side effects, and a higher patient satisfaction.

Adolescent↗
PubMed2005

Continuous infusion of ropivacaine for pain relief after iliac crest bone grafting for shoulder surgery.

BACKGROUND: The aim of the study was to compare the efficacy of either ropivacaine or placebo through an iliac crest (IC) catheter after Bankart repair with IC bone grafting. METHODS: With approval of the local ethics committee and after written informed consent was obtained, 36 patients had an interscalene catheter placed preoperatively. Intraoperatively, the surgeon placed a catheter at the IC donor site. At the end of surgery, 30 ml ropivacaine, 0.5% (ropivacaine group), or 30 ml NaCl, 0.9% (placebo group), was administered. Ropivacaine, 0.2%, was started 6 h after the initial block through the interscalene catheter for 48 h (t48) in all patients. At t0, the patient received either 5 ml/h ropivacaine, 0.2% (ropivacaine group), or 5 ml/h NaCl, 0.9% (placebo group), for 48 h through the IC catheter. All patients received an intravenous morphine patient-controlled analgesia device. Pain scores at the shoulder and at the IC donor site were assessed at rest and during motion every 8 h for 48 h and after 3 months. Plasma concentrations of total and unbound ropivacaine, morphine consumption, and patient satisfaction were assessed. RESULTS: At the IC donor site, pain was significantly lower in the ropivacaine group compared with the placebo group at rest and during motion at any time. Total and unbound plasma concentrations of ropivacaine were below the toxic threshold in both groups. Morphine consumption was significantly lower in the ropivacaine group after 24 and 48 h. Patient satisfaction was significantly higher in the ropivacaine group. At 3 months, pain at the IC during motion was significantly lower in the ropivacaine group. CONCLUSIONS: Continuous application of 0.2% ropivacaine through an IC catheter after Bankart repair with IC bone grafting is an effective method for pain relief for the first 48 h, with few adverse effects and high patient satisfaction. The benefit of this technique is still present after 3 months.

Adult↗
PubMed2004

Nerve injury and regional anaesthesia.

PURPOSE OF REVIEW: In recent years there has been a renewed interest in regional anaesthesia, particularly peripheral nerve blockade, not only to improve the patient's well being, but also to meet the requirements of modern orthopaedic surgery. Nerve injury in this context is the complication most feared by the patient, the anaesthesiologist and the surgeon. RECENT FINDINGS: To date, data dealing with the incidence of nerve injury in regional anaesthesia have almost exclusively been retrieved from close claims analysis. Recently, prospective, well controlled studies have shown that severe neurologic complications rarely occur: for the upper extremity, an incidence of 0.2-1% has been reported. New insights into the mechanisms of local anaesthetic neurotoxicity have demonstrated that ropivacaine has the least potential for neurotoxicity. Administration of the lowest possible concentrated solution of local anaesthetic is likely to be even less neurotoxic. The role of local anaesthetics in the development of apoptosis is nowadays well recognized. The consequences of other factors, such as nerve stretching and compression, in the pathology of nerve damage are emphasized. SUMMARY: Significant advances have been made in regional anaesthesia in the past 10 years. The introduction of catheter techniques has cleared the way for better regional anaesthetic and analgesic blocks. Studies dealing with placement of perineural catheters show that the catheter does not increase neurological complications. Properly performed, regional anaesthesia is a safe form of anaesthesia and the benefits far outweigh the risks.

Journal Article↗
PubMed2003

Orthopaedic surgery in the elderly.

The orthopaedic surgeon brings to the operating room some of the greatest challenges for the anaesthesiologist. Various factors, such as age, health status, disease process, type and extent of operative procedure, provide differing circumstances, which an anaesthesiologist is obliged to cope with. This contrasts to other surgical specialities in which patient factors and operative procedures are much more predictable. The number of older patients in orthopaedics is steadily growing, and the anaesthesiologist has to take all measures to permit an early and efficient rehabilitation, a concept which is now widely recognized for improving the success of orthopaedic surgical procedures. Factors which may hinder this concept are post-operative pain, central nervous system dysfunction, fatigue, deep sedation, delayed enteral feeding and absorption. There is no evidence that regional anaesthesia without the use of the continuous regional analgesic technique decreases morbidity and mortality as compared to general anaesthesia, in this context. However, the advantages of continuous analgesia through a perineural spinal or epidural catheter are promising and deserve further investigation. The concept of the optimal post-operative multimodal regimen needs to be defined. The application of NSAID and paracetamol is an integral part of this concept, and the dose of opioids should be titrated to the lowest efficient dose needed. Thus, this chapter discusses the different controversies and future trends of anaesthesia with regard to the elderly in orthopaedic surgery.

Aged↗
PubMed2003

Continuous interscalene analgesia with ropivacaine 2 mg/ml after major shoulder surgery.

BACKGROUND: In this open, randomized study, the pharmacokinetics, clinical efficacy, and safety of a 48-h continuous interscalene infusion of 2 mg/ml ropivacaine for postoperative pain relief were investigated in patients undergoing open major shoulder surgery. METHODS: An initial interscalene block with 30 ml ropivacaine, 7.5 mg/ml (225 mg), was performed. After completion of interscalene block, all patients (n = 24) received general anesthesia, and 6 h after interscalene block, a 48-h continuous interscalene infusion of 12 or 18 mg/h using 2 mg/ml ropivacaine was started. Total and unbound plasma concentrations of ropivacaine and 2.6-pipecoloxylidide (PPX; a major active metabolite) were determined during and up to 6 h after the interscalene infusion. Postoperative pain at rest was assessed by a visual analog scale. Supplementary analgesics and adverse events were recorded. RESULTS: Plasma concentrations of total and unbound ropivacaine were proportional to the total dose. At the end of the interscalene infusion of 9 ml/h, the mean +/- SD plasma concentrations of total and unbound ropivacaine were 1.40 +/- 0.54 and 0.03 +/- 0.01 mg/l, respectively, and of total and unbound PPX were 0.70 +/- 0.38 and 0.30 +/- 0.20 mg/l, respectively. Plasma concentrations of unbound ropivacaine and unbound PPX, added together, remained well below threshold levels for systemic central nervous system toxicity. There were no significant differences between the groups for postoperative pain (median maximum of about 20 mm on the visual analog scale in both groups), analgesic consumption, or quality of pain relief assessed by the patient. No signs or symptoms of systemic local anesthetic toxicity were observed. CONCLUSION: A 48-h continuous interscalene infusion of 6 or 9 ml/h ropivacaine, 2 mg/ml, started 6 h after an initial interscalene block of 30 ml ropivacaine, 7.5 mg/ml, provided satisfactory postoperative pain relief after major shoulder surgery and was well tolerated. Unbound plasma concentrations of ropivacaine and PPX remained well below threshold levels for systemic central nervous toxicity.

Adolescent↗