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Pertes et profits de l’analgésie péridurale

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Douleur et Analgésie

Résumé

L’antalgie post-opératoire est actuellement un sujet largement débattu. Bien que des progrès incontestables aient été réalisés dans le domaine de la physiologie et de la pharmacologie de la douleur, ainsi que dans la technologie médicale, il ressort des études récentes qu’un nombre encore élevé de patients souffrent de manière inacceptable après une opération. L’analgésie péridurale est une forme d’antalgie bien reconnue, mais également souvent débattue. Aussi, aborder ce sujet sous la forme d’une analyse coût/bénéfice pour le patient paraît pertinent. Les avantages de l’analgésie péridurale sont bien connus et indépendamment de la qualité même de l’analgésie il faut également y trouver des «profits secondaires», tels l’impact favorable sur la fonction pulmonaire, sur la maladie thromboembolique, sur la réponse au stress chirurgical, sur la morbidité et la mortalité post-opératoire. Pourtant, un certain nombre de questions restent sans réponse: la «lourdeur» du traitement en soi, la surveillance du patient, l’éducation des médecins et des infirmières, les problèmes d’éthique.

Pertes et Profits de l’Analgésie Péridurale est également l’analyse d’un bilan dont les conclusions se trouvent résumées dans ces deux mots:

  • •prudence: pour que les modalités de toute nouvelle forme de traitement de la douleur ne dépasse pas ses fondements scientifiques;

  • •espoir: de se donner tous les moyens, politiques, juridiques, financiers et scientifiques pour que le problème de la douleur soit pris en charge de manière globale.

Summary

Post-operative analgesis is a widely debatted subjet nowaday. Although there was a growing developpment in the knowledges of physiology and pharmacology of pain, as in the medical technology, many patients still suffer after surgery. Since many years, epidural analgesia is recognised as a potent alternative to systemic analgesia, especially in the treatment of post-operative pain. But it is important to discuss this form of analgesia in term of cost/benefit for the patient himself. Besides its well recognised quality, epidural analgesia has «second benefits» for the patient in term of positiv impact on several systems (lung function, thromboembolic disease, surgical stress, post-operative morbidity and mortality). Nevertheless some questions still remainded unanswered (epidural analgesia is a «heavy treatment», problems in relation to patient monitoring, responsability and ethic).

The assessment ofLosses and Benefits of Epidural Analgesia could be summarised in this two words:

  • •caution: the application of new technologies should not pass over their scientific foundation;

  • •hope: that we developp actively the political, legal, financial and scientific basis to be able to solve globally the post-operative pain problem.

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Authors and Affiliations

  1. Département d’Anesthésiologie, Hôpital Cantonal Universitaire de Genève, CH-1211, Genève 14

    C. E. Klopfenstein

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  1. C. E. Klopfenstein
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Texte présenté lors du Congrès de la SOFRED des 8 et 9 octobre 1992.

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Klopfenstein, C.E. Pertes et profits de l’analgésie péridurale. Doul. et Analg. 6, 35–39 (1993). https://doi.org/10.1007/BF03019254

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  • DOI: https://doi.org/10.1007/BF03019254

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