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Master Thesis

Anesthésie intra-focale, analyse des pratiques

Abstract : Background: Haematoma block (HB) is an analgesic technique used in the management of closed fractures. It has a favourable risk-benefit balance which makes it an interesting alternative in primary and emergency care. It is experiencing a revival of interest in Great Britain but is still not widespread in France. Our work aims to carry out an analysis of the practices and means of training currently available for intra-focal anaesthesia. Method : Prospective, multicentric observational study targeting doctors confronted with emergency trauma management - Mountain doctors and hospital emergency physicians. Anonymous online questionnaire. Results : 125 responses analysed. 53% were mountain doctors, 47% hospital emergency doctors. 86% of emergency physicians knew little or nothing about HB. 81% did not practice. 83% of mountain doctors knew AIF well or perfectly. 82% practiced it. 97% of the doctors questioned performed an analgesic AIF for orthopaedic reduction, 31% used it for pure analgesic purposes, and 22% to avoid another type of analgesia. Doctors used them to treat fractures of the distal end of the radius at 92%, collarbones at 52%, and metacarpals at 29%. 94% of doctors did not perform an HB if skin sepsis overlying the puncture site, 54% if associated vascular lesion, 45% if sensory-motor deficit, 52% if taking anticoagulants. 51% of physicians practicing HB combined a co-analgesia; 82% of physicians who practiced HB received practical training by peer mentoring and 45% received additional theoretical training. 65% of physicians who did not practice did not receive any training. 90% of doctors surveyed would like to participate in training. Conclusion : The practice of HB is currently very variable. It plays an important role in mountain medicine in the management of displaced wrist fractures and also collarbones. A desire for training, currently insufficient, was shown.
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Master Thesis
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Clément Thomas. Anesthésie intra-focale, analyse des pratiques. Médecine humaine et pathologie. 2018. ⟨dumas-01849835⟩

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