Effets indésirables des anesthésiques locaux en 2008 : études pharmaco-épidémiologiques en France
Institution:
Toulouse 3Disciplines:
Directors:
Abstract EN:
Main adverse drug reactions (ADR) to local anesthetics (LA) are neurological (seizures) and cardiologic (cardiac arrest). Using the French Pharmacovigilance Database, we sought to characterize the profile of ADR reported with the five commonest amide LA. We studied ADR reported to the French Network of PharmacoVigilance Centres occurring between 1995 and 2006. For each ADR, we noted the type of LA, type of ADR, as well as the imputability score. From our results, we performed two multicenter studies. We identified 727 reports (0. 3% of the total). Lidocaine (36%) and bupivacaine (35%) were the most often LA reported. Eight patients died. The most frequently reported ADRs were failure of the block (27. 7%) mainly during spinal anesthesia with bupivacaine, neurological (22%), allergic (19%) and cardiovascular (15%) ADR. After combining our results with the GERAP database, we selected 16 allergic reactions following local anesthetic injection, with 11 immediat-type reactions. In a multicenter study including 1214 spinal anesthesiae, failure rate was 3. 2%. Independant risk factors were identified. This is the first survey of ADRs involving LA and using such a database. Beside well-known ADRs, this study confirmed that LA-induced allergic reactions are rare but can occur. Spinal anesthesia failure becomes a reality with a significant incidence in daily practices.
Abstract FR:
Au cours des 20 dernières années, de nombreux changements ont affecté le monde du travail. Face à ces nouvelles conditions de stress, le salarié a du s'adapter, notamment par le recours aux médicaments. Dans ce travail, nous avons décrit l'évolution de la consommation de médicaments en milieu professionnel depuis 1986 montrant une modification d'usage des médicaments psychoactifs. D'autre part, nous avons retrouvé une association entre les contraintes professionnelles et l'initiation de consommation de ces médicaments, particulièrement chez les femmes. Enfin, dans une dernière partie, nous avons évalué l'impact de l'usage à long terme de médicaments psychoactifs et d'alcool sur les performances cognitives des salariés.