Summary :
Background:
The environmental restraints linked to medical devices in the OR expose the anesthesia team to the risk of bad posture, namely that of the Scapular Belt (SB). The main objective of this study is to monitor, in simulation during the performance of axillary block ultrasound guidance (ABUG), if an improved environment (IE) might reduce the frequency of deviant positions of the SB relative to the recommendations put forward by the French INRS (Institut National de Recherche et de Sécurité – National Institute of Research and Security), concerning occupational hazards (OH), in comparison with a standard environment (SE). On the other hand, we also examined the effect of the level of experience on the frequency of non-standard positions.
Materials and Method:
A controlled study was carried out at the “Centre Universitaire d’Enseignement par Simulation (CUESiM) de Nancy” – Nancy University College of Teaching by Simulation, which included 32 anesthesia practitioners. The SE was implemented thanks to observations done in a “centre hospitalier lorrain” – Lorraine region university hospital. The IE was carried out in collaboration with the Institut de Formation en Ergothérapie de Nancy – Nancy College of Occupational Therapy, using an upper extremity assistive orthosis. The sequence was examined from ultrasound tracking until puncture. Gestures were filmed and the videos were explored by the software KINOVEA©. Participants filled in a modified “TMS” (Troubles Musculosquelettiques) – MSD – Musculoskeletal Disorders questionnaire, followed by the subjective discomfort Borg Scale after each changeover. Data were analyzed through Wilcoxon non-parametrical tests of signed ranks in order to compare the two environments all over the studied parameters, a model of univaried logistic regression for the conformity of the OH according to the number of years of experience, and finally a McNemar test for the conformity to the OH.
Results and Discussion:
Of the 32 participants, it was found that 84.4% have never been aware of the risk prevention related to professional activities, and 12.9% have been suffering from shoulder disorders. As for 75% of the participants, the orthoses proved to be of a valuable improvement in their professional practice. The Borg discomfort scale shows a very significant difference (p<0.0001) with a lesser discomfort in the IE. We observe that the sequence lasts more in the IE: 52.2 +/- 22.6 sec vs 49.4 +/- 28.3 sec for the right puncture, 53.6 +/- 31.9 sec vs 41.7 +/- 26.8 sec for the left puncture (average +/- ET), p<0.0001. This statistical difference is not clinically significant. The number of years of experience is not an indication as to the use of a conform position relative to the OH (p>0.05). The use of orthosis increases the conformity to the OH (p<0.05).
Conlusion:
The optimization of the occupational environment proves efficient. It enhances the posture in local and regional anesthesia practice.
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Article rédigé par :
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Olivier Dossmann
Directeur
Institut de formation en ergothérapie de Lorraine et Champagne-Ardenne (IFE LCA)
4, rue des Sables
54000 Nancy
olivier.dossmann@ergo-nancy.com
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Jean Paysant
Pr en médecine, PU-PH
Médecine Physique et Réadaptation
IFE LCA
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Carole Cesari
Infirmière anesthésiste DE
École d’IADE, Nancy
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Gaëlle Cousin
Infirmière anesthésiste DE
École d’IADE, Nancy
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Florie Einsweiler
Infirmière anesthésiste DE
École d’IADE, Nancy
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Julien Schoendorf
Infirmier anesthésiste DE
École d’IADE, Nancy
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Hervé Bouaziz
Pr en médecine, PU-PH
Anesthésie Réanimation
École d’IADE, Nancy