Utilisation des cathéters périnerveux à domicile pour le traitement de la douleur chronique : les obstacles en 2016

Postoperative acute pain treatment by perineural catheter is frequently used at home. It requires an organization, which includes professional's training, the elaboration of protocols of care, team coordination, practice's evaluation. In chronic pathologies, the use of these catheters at home meets with numerous problems. In France, the law allows nurses to inject medication in perineural catheter. However, the list of the nursing acts, which was revised in 2014, has planed no remuneration for this care. This legal text is often badly interpreted, in particular regarding anesthesia and analgesia. The local anesthetic (ropivacaine) is used for both indications but at different concentrations, which increase professional' misunderstanding. Locally, some nursing labor syndicates, relayed by the Order of the nurses are opposed to this practice. Health insurances refuse its coverage. Regarding organized perfusion at home, in particular concerning the use of perineural catheter, a legal text is in preparation. Despite these obstacles, this nerve block is widely used at home to treat chronic pain. It is therefore urgent to solve these problems in order to allow patients - often times helpless - to have access to this treatment.