Regional Anaesthesia in Intensive Care Unit

Point-of-care Regional Anaesthesia in Intensive Care Unit. A Multicentric Professional Practice Evaluation

Status

Completed

Phases

Unknown

Study type

Observational

Source

ClinicalTrials.gov

Registry ID

NCT05131633

Acronym

Week'ALR

Enrollment

100

Registered

2021-11-23

Start date

2021-10-18

Completion date

2021-12-31

Last updated

2023-02-17

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Intensive Care Unit

Keywords

regional anesthesia, intensive care unit, analgesia, pain management

Brief summary

Pain is a major problem in Intensive Care Unit (ICU). Adequate pain management not only means decreasing the pain intensity, but also improving the functionality and allowing the early mobilization that is a prerequisite for improving recovery and decreasing the risk of complications in ICU. The complex problems involved in pain, analgesic interventions, and outcome have been emphasized in several surveys over the past decades, but apparently with only small improvements, despite the existence of several guidelines for perioperative pain management. Regional analgesia techniques (peripheral and neuraxial nerve blocks) have the potential to decrease the physiological stress response to trauma or surgery, reducing the possibility of surgical complications and improving the outcomes. Recent studies suggested that surgical and trauma ICU patients receive opioid-hypnotics continuous infusions to prevent pain and agitation that could increase the risk of posttraumatic stress disorder and chronic neuropathic pain symptoms, and chronic opioid use. Also they may reduce the total amount of opioid analgesics necessary to achieve adequate pain control and the development of potentially dangerous side effects. The use of the regional anesthesia technique in the ICU, however, can, in part, be limited by the presence of hemodynamic instability, bleeding diathesis, and by the fear of the performing procedures potentially associated with significant side effects in heavily sedated patients. Although regional anesthesia emerges as a new and very interesting player for pain management in ICU, today very few data exists about the use of RA (including PNB and neuraxial nerves blocks) by the practicians in ICU/stepdown units. The main objective of this study is to assess the use of RA for pain management both initiates in the operative room for surgical patients then transferred in ICU/stepdown units and performs directly by the practicians in ICU/stepdown units, in several french units.

Detailed description

Taken together, previous data indicate that regional anesthesia emerges as a new and very interesting player for pain management in ICU. Because very few data exist about the use of RA (including PNB and neuraxial nerves blocks) by the practicians in ICU we, therefore, design this multicentric professional practice evaluation to : * (1) , assess the use of RA in ICU/stepdown units but initiates by anesthesiologist in the operative room * (2) , assess the use of RA in ICU/stepdown units directly perform by practicians in ICU * (3) , describe the type, modalities and indications of RA performed This study will have no effect on the management of the ICU/stepdown units patients.

Interventions

None listed

Study design

Observational model

COHORT

Time perspective

PROSPECTIVE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Inclusion criteria

○ All medical, surgical, and trauma patients hospitalized in the participating centers and receiving RA during the one-week study period.

Exclusion criteria

* Opposition to the processing of personal data * Age \<18 years old * Absolute contraindications to the perform RA * Previous hypersensitivity or anaphylactic reaction to local anesthetics * Patient under a tutelage measure or placed under judicial protection

Design outcomes

Primary

Measure	Time frame	Description
Our primary objective is to assess the global use of RA in ICU/stepdown units	During 1 week of the study	. Number (prevalence) of RA performed in ICU over 1 week.

Secondary

Measure	Time frame	Description
Evaluation of success or not in RA	During 1 week of the study	Sensitive and/or motor block
Contraindication for RA	During 1 week of the study	Type of contraindication
Complication of RA	During 1 week of the study	Type of complication
Reason for removal cathete	During 1 week of the study	Type of reason
Duration of catheter	During 1 week of the study	Duration in days
ICU/stepdown units length of stay	Day 28 after the RA	Length in days
Hospital length of stay	Day 28 after the RA	Length in days
assess the use, in ICU/stepdown units patients, of RA previously initiated in the operative room by an anesthesiologist	During 1 week of the study	.Number of RA performed in operative room and then transferred in ICU over a week. . Prevalence of RA performed in the operative room and then transferred in ICU over a week
Type of RA	During 1 week of the study	Nerves block or spinal anesthesia or epidural anesthesia
Evaluation of analgesia	During 1 week of the study	Visual Analog Score for pain)
Who perform RA	During 1 week of the study	Resident or senior and intensivist or anesthesiologist
Name of local anesthetics used	During 1 week of the study	Name of local anesthetics used
Concentration of local anesthetics used	During 1 week of the study	Concentration in mg/ml
Indications for RA	During 1 week of the study	Analgesia or anesthesia or mobilization or nursing or weaning from mechanical ventilation
Technical management to perform RA	During 1 week of the study	Type of needle
Evaluation of vital status: on ICU/stepdown units discharge	Day 28 after the RA	—
Evaluation of vital status at day 28	Day 28 after the RA	Death or alive
Ventilator-free days to day 28	Day 28 after the RA	Unit : days
Location of RA	During 1 week of the study	ICU or step-down unit or operating room

Countries

France

Outcome results