Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, USA.
University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2019 Nov;66(11):1356-1384. doi: 10.1007/s12630-019-01466-w. Epub 2019 Aug 26.
The risk of bleeding complications during regional anesthesia procedures is a significant patient safety consideration. Nevertheless, existing literature provides limited guidance on the stratification of bleeding risk for peripheral nerve and newly described interfascial plane blocks. Our objective was to produce an evidence-based consensus advisory that classifies bleeding risks in patients undergoing regional peripheral nerve and interfascial plane block procedures. This advisory is intended to facilitate clinical decision-making in conjunction with national or local guidelines and to guide consideration for appropriate alterations to anticoagulation regimens before specific regional anesthesia procedures. In pursuit of this goal, the Regional Anesthesia and Acute Pain Section of the Canadian Anesthesiologists Society (CAS) assembled a panel of seven Canadian experts to classify the risk of bleeding complications associated with regional peripheral nerve and interfascial plane blocks. At the 75 annual meeting of the CAS in June 2018, the panel's expert opinion was finalized and the published literature was quantified within an organized framework. All common peripheral nerve and interfascial plane blocks were categorized into "low risk", "intermediate risk", and "high risk" based on the literature evidence, bleeding risk scores, and consensus opinion (in that order of priority). Clinical data is often limited, so readers of this consensus report should be reminded that these recommendations are mostly based on expert consensus. Hence, this advisory should not to be defined as a standard of care but rather serve as a resource for clinicians assessing the risk and benefits of regional anesthesia in management of their patients.
在区域麻醉过程中，出血并发症的风险是一个重要的患者安全考虑因素。然而，现有文献对周围神经和新描述的筋膜间平面阻滞的出血风险分层提供的指导有限。我们的目标是制定一个基于证据的共识咨询意见，对接受区域周围神经和筋膜间平面阻滞的患者的出血风险进行分类。该咨询意见旨在与国家或地方指南结合，为临床决策提供便利，并指导考虑在特定区域麻醉程序之前适当改变抗凝方案。为了实现这一目标，加拿大麻醉师学会（CAS）的区域麻醉和急性疼痛科组织了一个由七名加拿大专家组成的小组，对与区域周围神经和筋膜间平面阻滞相关的出血并发症风险进行分类。在 2018 年 6 月 CAS 的第 75 届年会上，小组的专家意见得到了最终确定，并在有组织的框架内对已发表的文献进行了量化。所有常见的周围神经和筋膜间平面阻滞都根据文献证据、出血风险评分和共识意见（按优先顺序）分为“低风险”、“中风险”和“高风险”。临床数据通常有限，因此，本共识报告的读者应注意，这些建议主要基于专家共识。因此，本咨询意见不应被定义为护理标准，而应作为临床医生评估其患者区域麻醉风险和收益的资源。
