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Reste-t-il des contre-indications à l’anesthésie locorégionale en obstétrique ?

Does it remain any contraindication to regional anaesthesia in obstetrics?

  • Article de Synthèse / Review Article
  • Published:
Revue de médecine périnatale

Résumé

L’anesthésie locorégionale périmédullaire (péridurale et rachianesthésie) représente la pierre angulaire de l’anesthésie et de l’analgésie obstétricale. En ce début de XXI e siècle, environ 80 % des parturientes bénéficient de ces techniques pour le travail et l’accouchement. Néanmoins, quelques rares situations représentent des contre-indications absolues ou relatives à la réalisation de ces techniques. Il convient de connaître ces situations afin non seulement de ne pas exposer nos patientes à un risque accru de complications mais également de ne pas les priver des bénéfices de ces techniques en élargissant indument le champ de ces contre-indications. Cet article passe en revue les problèmes liés au refus de la patiente, à l’infection localisée au site de ponction, à l’hypertension intracrânienne, à l’hypovolémie, aux troubles de l’hémostase héréditaires ou acquis, à l’allergie aux anesthésiques locaux, à l’hyperthermie, aux cardiopathies, aux affections neurologiques, aux anomalies du rachis, à la dilatation cervicale et aux tatouages lombaires.

Abstract

Regional anaesthesia (epidural and spinal) is the cornerstone of obstetric anaesthesia and analgesia. In the beginning of the 21st century, about 80% of the parturient take benefits from these techniques during labour and delivery. However, very few situations represent absolute or relative contraindications to regional anaesthesia. The adequate knowledge of these contraindications prevents to expose our patients to an increased risk of complications of regional techniques but also avoid depriving them of their benefits in the name of false contraindications. This paper reviews the problems of patient refusal, site of puncture’s infection, intracranial hypertension, hypovolemia, inherited and acquired coagulopathy, allergy to local anaesthetics, hyperthermia, cardiopathy, neurological diseases, spinal abnormalities, cervical dilation and lumbar tattoo. All together, it estimated that less than 0.5% of the parturient are contraindicated to regional anaesthesia in obstetrics.

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  1. Service universitaire d’anesthésie-réanimation, CHU Liège, CHR de la Citadelle Liège, 1, boulevard du Douzième de Ligne, 4000, Liège, Belgique

    P. -Y. Dewandre

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Dewandre, P.Y. Reste-t-il des contre-indications à l’anesthésie locorégionale en obstétrique ?. Rev. med. perinat. 4, 99–104 (2012). https://doi.org/10.1007/s12611-012-0194-4

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  • DOI: https://doi.org/10.1007/s12611-012-0194-4

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