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Master Thesis

Anesthésie intra-focale : analyse des pratiques

Abstract : Background: Hematoma block (HB) is an analgesic technique used in the management of closed fractures. It has a favourable benefit-risk 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 hematoma block. 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 HB well or perfectly. 82% practiced it. 97% of the doctors questioned performed an analgesic HB 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 was overlying the puncture site, 54% if there was a vascular lesion associated, 45% if sensory-motor deficit was detected, 52% if the patient was 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 primarily in the management of displaced wrist fractures and collarbones. A desire for training, currently insufficient, was shown.
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Submitted on : Wednesday, December 18, 2019 - 12:02:57 PM
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Lauren Somers. Anesthésie intra-focale : analyse des pratiques. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02417607⟩



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