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Provenzano DA, Hanes M, Hunt C, Benzon HT, Grider JS, Cawcutt K, Doshi TL, Hayek S, Hoelzer B, Johnson RL, Kalagara H, Kopp S, Loftus RW, Macfarlane AJR, Nagpal AS, Neuman SA, Pawa A, Pearson ACS, Pilitsis J, Sivanesan E, Sondekoppam RV, Van Zundert J, Narouze S. ASRA Pain Medicine consensus practice infection control guidelines for regional anesthesia and pain medicine. Reg Anesth Pain Med 2025:rapm-2024-105651. [PMID: 39837579 DOI: 10.1136/rapm-2024-105651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 08/27/2024] [Indexed: 01/23/2025]
Abstract
BACKGROUND To provide recommendations on risk mitigation, diagnosis and treatment of infectious complications associated with the practice of regional anesthesia, acute and chronic pain management. METHODS Following board approval, in 2020 the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) commissioned evidence-based guidelines for best practices for infection control. More than 80 research questions were developed and literature searches undertaken by assigned working groups comprising four to five members. Modified US Preventive Services Task Force criteria were used to determine levels of evidence and certainty. Using a modified Delphi method, >50% agreement was needed to accept a recommendation for author review, and >75% agreement for a recommendation to be accepted. The ASRA Pain Medicine Board of Directors reviewed and approved the final guidelines. RESULTS After documenting the incidence and infectious complications associated with regional anesthesia and interventional pain procedures including implanted devices, we made recommendations regarding the role of the anesthesiologist and pain physician in infection control, preoperative patient risk factors and management, sterile technique, equipment use and maintenance, healthcare setting (office, hospital, operating room), surgical technique, postoperative risk reduction, and infection symptoms, diagnosis, and treatment. Consensus recommendations were based on risks associated with different settings and procedures, and keeping in mind each patient's unique characteristics. CONCLUSIONS The recommendations are intended to be multidisciplinary guidelines for clinical care and clinical decision-making in the regional anesthesia and chronic interventional pain practice. The issues addressed are constantly evolving, therefore, consistent updating will be required.
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Affiliation(s)
| | - Michael Hanes
- Jax Spine and Pain Centers, Jacksonville, Florida, USA
| | - Christine Hunt
- Anesthesiology-Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Honorio T Benzon
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Pain Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Jay S Grider
- Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, USA
| | - Kelly Cawcutt
- Division of Infectious Diseases and Pulmonary & Critical Care Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tina L Doshi
- Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Pain Medicine, John Hopkins University, Baltimore, Maryland, USA
- Department of Neurosurgery, John Hopkins University, Baltimore, Maryland, USA
| | - Salim Hayek
- Anesthesiology, Case Western Reserve University, Cleveland, Ohio, USA
- University Hospitals of Cleveland, Cleveland, Ohio, USA
| | | | - Rebecca L Johnson
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Sandra Kopp
- Anesthesiology, Mayo Clinic Graduate School for Biomedical Sciences, Rochester, Minnesota, USA
| | - Randy W Loftus
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ameet S Nagpal
- Department of Orthopaedics and Physical Medicine & Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephanie A Neuman
- Department of Pain Medicine, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Amit Pawa
- Department of Theatres, Anaesthesia and Perioperative Medicine, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- King's College London, London, UK
| | - Amy C S Pearson
- Anesthesia, Advocate Aurora Health Inc, Milwaukee, Wisconsin, USA
| | | | - Eellan Sivanesan
- Neuromodulation, Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rakesh V Sondekoppam
- Department of Anesthesia, Pain, and Perioperative Medicine, Stanford University, Palo Alto, California, USA
| | - Jan Van Zundert
- Anesthesiology and Pain Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
- Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Samer Narouze
- Division of Pain Management, University Hospitals, Cleveland, Ohio, USA
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