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Master Thesis

Prise en charge ambulatoire des chirurgies de l'avant-pied chez l'enfant

Abstract : Background :
Addition of dexamethasone to local anaesthetic in sciatic block is an easy and safe way to prolong analgesia and may enable an ambulatory strategy in forefoot surgeries. The aim of our study was to compare outpatient care versus traditional hospitalization in children undergoing forefoot surgery in terms of early rehabilitation and analgesia.
Methods :
Two groups were compared: a retrospective group of children hospitalized (OH) between October 2013 and June 2015 and a prospective group of children treated as outpatients (GDC) between July 2015 and December 2016. Both had surgeries of hallux valgus and scaphoid supernumerary bone. Combination of dexamethasone IV (0,2mg/kg) and ropivacaine (0,5mg/kg) in sciatic block was provided in GDC. Outcome measures were collected retrospectively for hospitalized children and prospectively for GDC, by phone call on day 1 (DI) and day 2 (D2). Primary outcome was pain scores achieved during the 2 days following surgery. Rescue analgesic consumption, parental satisfaction scores and adverse events were secondary outcomes.
Results :
A total of 58 operations performed by a single surgeon were included in the study. Thirty children were included in GH compared with 28 GDC. Pain scores obtained during the first 24h (respectively 2.4 +/- 2.8 vs 1.6 +1- .1.9, p = 0.21) and between 24-48 hours (3.1 +/-3.1 vs 4.2 +/- -2.9, p = 0.098) were not statistically differents. Only rescue analgesic consumption was significantly higher in the GDC during the first 24 hours (OR = 0.21, 95% CI = [0.05 - 0.73] p = 0.007). In GDC, no child was re-hospitalized within the 30 days following surgery and the satisfaction score was 9.1 / 10. Conclusion : Combination of dexamethasone and locoregional analgesia does not expose children to greater pain or greater risk of immediate complications compared to traditional hospitalization. This strategy therefore appears to be particularly suited to forefoot surgeries.
Document type :
Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01524427
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Submitted on : Thursday, May 18, 2017 - 10:33:04 AM
Last modification on : Monday, December 2, 2019 - 10:24:01 AM

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  • HAL Id : dumas-01524427, version 1

Citation

Lucile Levasseur. Prise en charge ambulatoire des chirurgies de l'avant-pied chez l'enfant. Médecine humaine et pathologie. 2017. ⟨dumas-01524427⟩

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