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Master thesis

Traitement par néfopam des douleurs abdominales de l'adulte en médecine ambulatoire d'urgence par les praticiens de SOS Médecins 54 : enquête de pratiques sur l'utilisation des voies injectable et sub-linguale

Abstract : We present at first the néfopam ACUPAN. It is normally administered in injectable (INJ), but sometimes given in sublingual (SL) except official authorization ?AMM?. We land on the second part, the recommendations of the analgesic treatment according to the conferences of consensus. In the third part, we loosen published studies and our experience, a practical guide in aid of the general practitioners for the care of an acute abdominal pain. The fourth part concerns an original study which is an observation of the practices of ?SOS Médecins 54? on the usage of the néfopam in the abdominal pain. Aim: no study had demonstrated the efficiency of Acupan in ambulatory context. Methods: we realized a forward-looking survey based on a questionnaire filled by the practitioner and an evaluation by the patient himself. It concerned 101 patients presenting abdominal pains recruited over a period of 3,5 months. For all these patients were estimated the level of the pain by means of a numeric verbal scale (NVS) tested before treatment by néfopam and one hour after the administration, the efficiency and the tolerance during the following 24-48h by phone reminder of the patient. Results: the choice of the way fell to the doctor: 61 received the néfopam INJ and 40 from SL. The néfopam decreased significantly the level of the pain on the NVS of 4 in the group INJ and 3 in the group SL. The observed side effects are respectively for the way INJ and SL: unpleasant sensation (39 % versus 18 %), slumber (24 % vs 15 %), nausea-vomit (23 % vs 0 %), oral drought (15 % vs 13 %), sweats (8 % vs 0 %). Conclusion: néfopam is effective in ambulatory, and also in SL with an interesting profile of side effects. The comparison between ways INJ and SL would deserve to be studied in a randomized essay.
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Thierry Heissat. Traitement par néfopam des douleurs abdominales de l'adulte en médecine ambulatoire d'urgence par les praticiens de SOS Médecins 54 : enquête de pratiques sur l'utilisation des voies injectable et sub-linguale. Sciences du Vivant [q-bio]. 2009. ⟨hal-01734476⟩

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