Kohan Lynn, Salajegheh Reza, Hamill-Ruth Robin J, Yerra Sandeep, Butz John
Department of Anesthesiology, University of Virginia, Charlottesville, VA.
West River Anesthesiology Consultants, Rapid City, SD, USA.
J Pain Res. 2017 Mar 17;10:625-634. doi: 10.2147/JPR.S126851. eCollection 2017.
Other than the newly published anticoagulation guidelines, there are currently few recommendations to assist pain medicine physicians in determining the safety parameters to follow when performing interventional pain procedures. Little information exists regarding policies for oral intake, cumulative steroid dose limits, driving restrictions with and without sedation, and routine medication use for interventional procedures.
A 16-question survey was developed on common policies currently in use for interventional pain procedures. The questionnaire was distributed through the American Society of Regional Anesthesia and Pain Medicine and American Academy of Pain Medicine. We sought to statistically analyze the range of policies being used by pain medicine physicians and to determine if there are any commonly accepted standards.
A total of 337 physicians out of 4037 members responded to our survey with a response rate of 8.4%. A total of 82% of these respondents used a sedative agent while performing an interventional pain procedure. The majority of respondents required drivers after procedures, except after trigger points. A total of 47% indicated that they have an nil per os (NPO) policy for procedures without sedation. A total of 98% reported that they had an anticoagulation policy before an interventional procedure. A total of 17% indicated that the interval between steroid doses was <2 weeks, while 53% indicated that they waited 2-4 weeks between steroid doses.
Our study has clearly demonstrated a wide variation in the current practice among physicians regarding sedation, NPO status, steroid administration, and the need for designated drivers. There was much higher endorsement of policies regarding anticoagulation. There is an obvious need for evidence-based guidelines for these aspects of interventional pain care to improve patient safety and minimize the risk of adverse events.
除了新发布的抗凝指南外，目前几乎没有建议可协助疼痛医学医生确定进行介入性疼痛治疗时应遵循的安全参数。关于口服摄入政策、累积类固醇剂量限制、有无镇静情况下的驾驶限制以及介入手术常规用药方面的信息很少。
针对目前介入性疼痛治疗常用政策编制了一份包含16个问题的调查问卷。该问卷通过美国区域麻醉与疼痛医学学会以及美国疼痛医学学会进行分发。我们试图对疼痛医学医生所采用政策的范围进行统计分析，并确定是否存在任何普遍接受的标准。
4037名会员中共有337名医生回复了我们的调查，回复率为8.4%。这些受访者中共有82%在进行介入性疼痛治疗时使用了镇静剂。除触发点治疗后外，大多数受访者要求术后有人陪同驾驶。共有47%的受访者表示他们对无镇静的手术有禁食政策。共有98%的受访者报告称他们在介入手术前有抗凝政策。共有17%的受访者表示类固醇剂量间隔<2周，而53%的受访者表示他们在类固醇剂量之间等待2 - 4周。
我们的研究清楚地表明，目前医生在镇静、禁食状态、类固醇给药以及指定司机需求等方面的实践存在很大差异。对抗凝政策的认可程度要高得多。显然需要基于证据的介入性疼痛护理这些方面的指南，以提高患者安全性并将不良事件风险降至最低。
