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- W4313558013 abstract "Le plexus lombal innerve la partie antéro-médiale de la racine du membre inférieur. La chirurgie du genou et de la hanche sont des chirurgies fonctionnelles pourvoyeuses de douleurs post-opératoires potentiellement sévères et d’une incidence élevée de chronicisation douloureuse. L’analgésie balancée, insuffisante pour assurer seule la réhabilitation postopératoire, doit être généralement associée à une analgésie régionale intéressant le plexus lombal et ses branches. Les abords classiques plexiques et tronculaires, comme le bloc du nerf fémoral, ont été délaissés au profit de techniques infiltratives ou interfasciales. Parmi les blocs plus distaux, le PENG bloc, le bloc au canal des adducteurs, l’infiltration chirurgicale du site opératoire ont pour avantage de réduire l’incidence du bloc moteur du quadriceps induit par les blocs nerveux classiques plus proximaux. L’inconvénient majeur des abord plus distaux reste une moindre qualité d’analgésie notamment au-delà des premières heures et l’absence d’injection continue postopératoire. Chaque équipe doit convenir, par type de procédure chirurgicale, d’une combinaison de techniques pouvant allier confort du patient, impératifs chirurgicaux et réhabilitation. The lumbar plexus innervates the anteromedial part of the upper lower limb. Knee and hip surgery are functional surgeries with potentially severe post-operative pain and a high incidence of chronic pain. Multimodal analgesia, insufficient to ensure postoperative rehabilitation alone, must generally be associated with regional analgesia involving the lumbar plexus and its branches. The classical plexus and trunk approaches, such as the femoral nerve block, have been deleted in favor of infiltrative or interfascial techniques. Among the more distal blocks, the PENG block, the adductor canal block, and surgical infiltration of the surgical site have the advantage of reducing the incidence of quadriceps motor block induced by the more proximal classical nerve blocks. The major disadvantage of the more distal approaches remains a lower quality of analgesia, particularly beyond the first few hours, and the absence of continuous postoperative injection. Each team must agree, for each type of surgical procedure, on a combination of techniques that can combine patient comfort, surgical requirements, and rehabilitation." @default.
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- W4313558013 date "2023-01-01" @default.
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- W4313558013 title "Le plexus lombal et ses branches" @default.
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- W4313558013 doi "https://doi.org/10.1016/j.anrea.2022.12.006" @default.
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