Provenzano David Anthony, Hanes Michael, Hunt Christine, Benzon Honorio T, Grider Jay S, Cawcutt Kelly, Doshi Tina L, Hayek Salim, Hoelzer Bryan, Johnson Rebecca L, Kalagara Hari, Kopp Sandra, Loftus Randy W, Macfarlane Alan James Robert, Nagpal Ameet S, Neuman Stephanie A, Pawa Amit, Pearson Amy C S, Pilitsis Julie, Sivanesan Eellan, Sondekoppam Rakesh V, Van Zundert Jan, Narouze Samer
Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, USA
Jax Spine and Pain Centers, Jacksonville, Florida, USA.
Reg Anesth Pain Med. 2025 Jul 17. doi: 10.1136/rapm-2024-105651.
To provide recommendations on risk mitigation, diagnosis and treatment of infectious complications associated with the practice of regional anesthesia, acute and chronic pain management.
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.
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.
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.
为降低与区域麻醉、急慢性疼痛管理相关的感染并发症的风险、诊断和治疗提供建议。
经委员会批准，2020年美国区域麻醉与疼痛医学学会（ASRA疼痛医学）委托制定基于证据的感染控制最佳实践指南。由四至五名成员组成的指定工作组提出了80多个研究问题并进行了文献检索。采用修改后的美国预防服务工作组标准来确定证据水平和确定性。使用修改后的德尔菲法，接受一项建议以供作者审查需要超过50%的同意率，接受一项建议需要超过75%的同意率。ASRA疼痛医学董事会审查并批准了最终指南。
在记录了与区域麻醉和包括植入装置在内的介入性疼痛治疗相关的发病率和感染并发症后，我们就麻醉医生和疼痛医生在感染控制中的作用、术前患者风险因素及管理、无菌技术、设备使用和维护、医疗环境（办公室、医院、手术室）、手术技术、术后风险降低以及感染症状、诊断和治疗提出了建议。共识性建议基于与不同环境和治疗相关的风险，并考虑到每位患者的独特特征。
这些建议旨在成为区域麻醉和慢性介入性疼痛治疗中临床护理和临床决策的多学科指南。所涉及的问题不断发展，因此需要持续更新。
