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Techniques locorégionales d’analgésie en réanimation adulte

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Analgésie et sédation en réanimation

Part of the book series: Le point sur ... ((POINT))

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L’analgésie intraveineuse ou la sédation-analgésie sont les techniques de référence en réanimation. Dans certaines situations, les techniques d’analgésie locorégionales présentent une alternative intéressante. Lorsqu’elles sont applicables, les techniques locorégionales ont plusieurs avantages: un contrôle sélectif et de meilleure qualité de la douleur (principalement à la mobilisation), un effet d’épargne en opiacés évitant leurs effets secondaires. Plusieurs techniques d’analgésie régionales sont à la disposition du réanimateur. L’analgésie péridurale est la plus connue. Cette technique s’applique principalement aux patients ayant subi une chirurgie majeure thoracique ou abdominale. Pour les pathologies spécifiques de réanimation, cette technique s’applique aux patients souffrant de fractures de côtes multiples ou de pancréatite aiguë. Les indications des blocs périnerveux continus concernent les patients polytraumatisés souffrant de fractures des extrémités chez qui les mobilisations sont douloureuses. Dans ce contexte, les blocs périnerveux seront préférés à l’analgésie péridurale du fait de leur absence d’effets hémodynamiques. Le bloc paravertébral est préférable à l’analgésie péridurale dans le cadre de la chirurgie thoracique. La mise en place d’une technique d’analgésie locorégionale doit obéir à des règles strictes. Le consentement du patient est important. Le patient de réanimation est un sujet à risque d’hypovolémie, d’instabilité hémodynamique et de coagulopathie. L’ensemble de ces risques doit être pris en compte dans la gestion des cathéters d’analgésie.

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  1. C. Rapon
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  2. P. Alfonsi
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Rapon, C., Alfonsi, P. (2010). Techniques locorégionales d’analgésie en réanimation adulte. In: Analgésie et sédation en réanimation. Le point sur .... Springer, Paris. https://doi.org/10.1007/978-2-287-99029-8_3

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  • DOI: https://doi.org/10.1007/978-2-287-99029-8_3

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