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Master Thesis

Évaluation par pupillométrie de l'efficacité d'une analgésie loco-régionale sous anesthésie générale

Abstract : Background. Pupillary reflex dilation (PRD) appears as a reliable indicator of response to noxious stimulation. However, its ability to detect the effects of unilateral peripheral nerve block during general anaesthesia with opioids remains unknown. Methods. We studied 24 adult patients undergoing elective foot or ankle surgery. They each received unilateral popliteal sciatic nerve block with 0.75% ropivacaine and 1% lidocaine, then a steady-state infusion of propofol and remifentanil. Pupil diameters were measured before surgery using a video-based pupillometer to monitor PRD responses during bilaterally applied tetanic stimulation in the skin area innervated by sciatic nerve (5 s/60-mA/100 Hz). Results. No changes in systolic blood pressure, heart rate or bispectral index were found during tetanic stimulation. Pupillary response to tetanic stimulation varied substantially according to whether the leg was under normal or sensory nerve block conditions. Sensory nerve block led to a blunted maximal PRD response to noxious stimulation compared to the normal condition: median 2% from baseline versus 17%, respectively (P <0.01). A PRD response of less than 10% was indicative of abolished pain perception (sensitivity 96%, specificity 100%). The PRD difference between the two stimulated regions persisted over time through the 5-s long stimulus and the recovery phase. Conclusions. The effects of peripheral nerve block can be detected with the use of PRD response to slight noxious stimulation in patients receiving propofol-remifentanil anaesthesia. Pupillometry appears to be a sensitive approach to assess small changes in pain perception even during administration of opioids.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-00683007
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Submitted on : Tuesday, March 27, 2012 - 3:00:40 PM
Last modification on : Tuesday, May 11, 2021 - 11:36:17 AM
Long-term archiving on: : Monday, November 26, 2012 - 12:15:52 PM

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Sylvain Isnardon. Évaluation par pupillométrie de l'efficacité d'une analgésie loco-régionale sous anesthésie générale. Médecine humaine et pathologie. 2012. ⟨dumas-00683007⟩

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