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French clinical guidelines for peripheral motor nerve blocks in a PRM setting - 28/06/19

Doi : 10.1016/j.rehab.2019.06.001 
Alain P. Yelnik a, , Claire Hentzen a, Philippe Cuvillon b, Etienne Allart c, Isabelle V. Bonan d, François C. Boyer e, Flavia Coroian f, François Genet g, Thibaud Honore d, Marylène Jousse a, Dominique Fletcher h, Lionel Velly i, Isabelle Laffont f,

SOFMER group

SFAR group

Eric Viel b
a PRM Department, Paris Diderot University, Groupe Hospitalier Saint-Louis – Lariboisière – F.-Widal, AP–HP, 200, rue Faubourg-Saint-Denis, 75010 Paris, France 
b Anesthesia and intensive care Department, Carémeau University Hospital, 30000 Nîmes, France 
c Neurorehabilitation Unit, Lille University Medical Center, 59000 Lille, France 
d PRM Department, University Hospital; Faculty of Medicine, University of Rennes 1, 2, rue Henri-le-Guilloux, 35000 Rennes, France 
e PRM Department, Reims Champagne Ardenne University, Sebastopol Hospital, 48, rue de Sebastopol, 51092 Reims, France 
f PRM Department, Montpellier University Hospital, Euromov, IFRH, 34000 Montpellier, France 
g PRM Department, Versailles St. Quentin University, R.-Poincaré Hospital, 92380 Garches, France 
h Anesthesia Department Ambroise-Paré Hospital, AP–HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France 
i Anesthesia and Intensive Care Department, CHU Timone, Institut de Neurosciences de la Timone, UMR 7289, 13000 Marseille, France 

Corresponding author.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le vendredi 28 juin 2019
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Highlights

French guidelines for the practice of motor nerve blocks with anesthetic drug in Physical and Rehabilitation Medicine (PRM) from the French PRM (SOFMER) and Anesthesia and Intensive care (SFAR) societies are presented.
Eight issues are addressed: which blocks and indications; drugs and contraindications; medical survey; attitude in case of any adverse event; injection and guidance material; patient’ preparation and pain relief; efficacy assessment; patient’ information; PRM physiatrist education.
The main question deals with the recommendation about doses for each drug: for lidocaine – up to 2mg/kg – “check contraindications, emergency truck available, no need of previous anesthetic consultation nor presence of an anesthetist”; for ropivacaine – up to 1.5mg/kg, with a maximum of 100mg – the same but after intravenous line. Beyond these doses, SFAR guidelines should be applied with the aid of an anaesthetist.

Le texte complet de cet article est disponible en PDF.

Abstract

Introduction

Motor nerve blocks with anesthetic drug for local anesthesia are commonly used in physical and rehabilitation medicine (PRM), especially in the field of spasticity. Guidelines in this context are currently lacking.

Method

Eighteen experts selected on the basis of their recognized experience by the scientific committees of the French PRM (SOFMER) and Anesthesia and Intensive care (SFAR) societies were invited to work and propose guidelines for the use of loco-regional anesthetic drug for motor nerve blocks in PRM setting. Eight issues were addressed: which neural blocks for which indications; drugs and contraindications; medical survey and attitude in case of adverse event; injection and guidance material; patient preparation and pain relief; efficacy assessment; patient information; education of PRM physiatrists. The Medline, Cochrane and Embase databases for the period 1999 to 2018 were consulted and 355 papers analyzed. The drafts were commented then approved by the whole group using electronic vote, before final approval by scientific committee of each society.

Results

No scientific evidence emerged from the literature. Thus, these guidelines are mainly based on the opinion of the expert panel. Guidelines for each issue are reported with the main points of arguments. The main question deals with the recommendation about doses for each drug: for lidocaine – up to 2mg/kg – “check contraindications, emergency truck available, no need of previous anesthetic consultation nor presence of anesthetic physician”; for ropivacaine – up to 1.5mg/kg, with a maximum of 100mg – the same but after intravenous line. Beyond these doses, SFAR guidelines have to be applied with the need of anesthetic physician.

Conclusion

These are the first organizational guidelines devoted to increase the security of motor nerve block use in PRM settings.

Le texte complet de cet article est disponible en PDF.

Keywords : Motor nerve block, Physical and rehabilitation medicine, Spasticity, Rehabilitation


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