Postoperative Patient-controlled Perineural Analgesia After Orthopedic Surgery by "Remote Control" Versus "Bedside Care"
Postoperative Patient-controlled Perineural Analgesia After Orthopedic Surgery by "Remote Control" Versus "Bedside Care"
Perineural injection of local anesthesic is currently the reference method for the treatment
 of post operative pain in a patient undergoing major orthopedic surgery. Postoperative pain
 is a dynamic phenomena in every patient. It is classified as intense during the first
 postoperative hours after surgery, and decreases in a non-linear manner over the days
 following the procedure. PCA (patient control analgesia) infusion of local anesthesic allows
 an adaptation of the local analgesia doses to the evaluated pain scores, as well as permit a
 decrease in adverse events related to the continuous infusion technique (motor or sensory
 blockade, paresthesia, etc.). The physician can also modify the pump settings according to
 the postoperative rehabilitation plan.The use of new communication techniques such as
 "telemedecine" may be of interest in reducing treatment onset time and optimizing pain
 management. The remote control consists to change the settings of the pump after if the
 anesthesiologist was informed in real time (via a smartphone or a tablet) on patient pain
 level, sensory and motor blockades. The physician goes to a dedicated website (Micrel
 CareTM). and makes the necessary changes by remote control via a GPRS (General Packet Radio
 Service) connexion. The aim of this prospective, comparative, multicentric trial is to
 compare the effectiveness of patient management through two communication modalities: remote
 control versus bedside care.
Inclusion Criteria:

 -  Patients scheduled for elective orthopedic surgery

 -  Patients older than 18 years old

 -  Patient with a surgical indication (foot, shoulder or knee) which can require
 placement of a perineural catheter

 -  Patients classified ASA class I to III

 -  Informed consent

 Exclusion Criteria:

 -  Contraindication to regional anesthesia or local anesthetics

 -  Contraindication to paracetamol, ketoprofen or morphine (depending on the selected
 rescue analgesia)

 -  Hospital discharge less than 48 hours after surgery

 -  Psychomotor disease (teletransmission contraindication)

 -  Patient undergoing surgery with a duration greater than 4 hours

 -  Patient with a duration of perineural catheter less than 48 hours

 -  Protected patient

 -  Patient enrolled in another study

 -  Patient who can't understand local language