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Annales françaises d'anesthésie et de réanimation, v.17 no.6, 1998년, pp.471 - 493
Beaussier, M
AI-Helper
AbstractType of surgery is the most important factor conditionning intensity and duration of postoperative pain. Thoracic and spinal surgery are the most painfull procedures. Abdominal, urologic and orthopedic surgery lead to severe postoperative pain. Duration of severe pain rarely exceeds 72 hours...
RésuméLa douleur postopératoire est très variable en intensité et en durée, selon le type de chirurgie. C'est la raison pour laquelle la transposition de protocoles analgésiques d'une chirurgie à l'autre peut conduire à un échec. Les actes donnant lieu aux douleurs post-opératoires les plus fortes sont les interventions thoraciques et rachidiennes. Viennent ensuite la chirurgie digestive, rénale et orthopédique. La durée des douleurs de forte intensité dépasse rarement 72 heures. Les interventions thoraciques, abdominales et orthopédiques donnent lieu à une recrudescence des douleurs lors des mouvements ou de la rééducation. La douleur des procédures chirurgicales mineures réalisées en ambulatoire, est souvent assez importante et ne doit pas être sous-estimée. Il est très difficile de mettre en évidence les répercussions postopératoires de la douleur. En effet, toutes les techniques analgésiques ont des effets propres sur la morbidité post-opératoire, introduisant de nombreux facteurs indépendants de l'efficacité analgésique. Chez le sujet ne présentant pas de facteurs de risque, la morbidité respiratoire et cardiovasculaire postopératoire n'est pas influencée par la douleur. Il en est peut-être autrement dans la population de patients exposés à la sur-venue de ces complications. C'est plus l'acte chirurgical que la douleur qui conditionne les perturbations métaboliques et la fatigue postopératoire. Une bonne analgésie pourrait permettre l'application de mesures actives de rééducation postopératoire, pouvant raccourcir la durée d'hospitalisation et de convalescence après chirurgie orthopédique ou abdominale.
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