Regional Anaesthesia in Intensive Care Unit

Study Overview
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Brief Summary
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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
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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.

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

Conditions
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Intensive Care Unit

Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

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

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| assess the use, in ICU/stepdown units patients, of RA previously initiated in the operative room by an anesthesiologist | .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 | During 1 week of the study | 
| Type of RA | Nerves block or spinal anesthesia or epidural anesthesia | During 1 week of the study | 
| Location of RA | ICU or step-down unit or operating room | During 1 week of the study | 
| Who perform RA | Resident or senior and intensivist or anesthesiologist | During 1 week of the study | 
| Name of local anesthetics used | Name of local anesthetics used | During 1 week of the study | 
| Concentration of local anesthetics used | Concentration in mg/ml | During 1 week of the study | 
| Indications for RA | Analgesia or anesthesia or mobilization or nursing or weaning from mechanical ventilation | During 1 week of the study | 
| Technical management to perform RA | Type of needle | During 1 week of the study | 
| Technical management to perform RA | Use of sonography (yes / no) | During 1 week of the study | 
| Technical management to perform RA | Use of electrical nerve stimulator (yes / no) | During 1 week of the study | 
| Technical management to perform RA | Use of continuous catheter (yes / no) | During 1 week of the study | 
| Evaluation of analgesia | Visual Analog Score for pain) | During 1 week of the study | 
| Evaluation of success or not in RA | Sensitive and/or motor block | During 1 week of the study | 
| Contraindication for RA | Type of contraindication | During 1 week of the study | 
| Complication of RA | Type of complication | During 1 week of the study | 
| Reason for removal cathete | Type of reason | During 1 week of the study | 
| Duration of catheter | Duration in days | During 1 week of the study | 
| ICU/stepdown units length of stay | Length in days | Day 28 after the RA | 
| Hospital length of stay | Length in days | Day 28 after the RA | 
| Evaluation of vital status: on ICU/stepdown units discharge |  | Day 28 after the RA | 
| Evaluation of vital status at day 28 | Death or alive | Day 28 after the RA | 
| Ventilator-free days to day 28 | Unit : days | Day 28 after the RA | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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regional anesthesia, intensive care unit, analgesia, pain management