Recent ASRA guidelines have attempted to align regional and pain guidelines, but this is not always possible. Why are there separate regional and pain guidelines? Pain procedures are more often treating elderly patients, patients with spinal stenosis, and scarring postlaminectomy patients. All patients had normal coagulation studies and followed ASRA guidelines. This prompted the ASRA board to create separate pain anticoagulation guidelines.
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Reg Anesth Pain Med. Comment in Reg Anesth Pain Med. Those surveyed agreed that procedure-specific and patient-specific factors required separate guidelines for pain and spine procedures.
In response, a guidelines committee was formed. After preliminary review of published complications reports and studies, the committee stratified interventional spine and pain procedures according to potential bleeding risk: low-, intermediate-, and high-risk procedures. The ASRA regional anesthesia anticoagulation guidelines were largely deemed appropriate for the low- and intermediate-risk categories, but the high-risk category required further investigation.
The first guidelines specific to interventional spine and pain procedures were published in Recent reviews evaluating bleeding complications in patients undergoing specific interventional pain procedures, the development of new regional anesthesia and acute pain guidelines, and the development of new anticoagulants and antiplatelet medications necessitate complementary updated guidelines. The authors desired coordination with the authors of the recently updated regional and acute pain anticoagulation guidelines.
The latest evidence was sought through extensive database search strategies and the recommendations were evidence based when available and pharmacology driven otherwise. We could not provide strength and grading of these recommendations because there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations.
This publication is intended as a living document to be updated periodically with consideration of new evidence.
Articles: Anticoagulation guidelines
ASRA ANTICOAGULATION GUIDELINES 2013 PDF
The Daily Dose • Sunday, May 19