Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Mar 17:10:625-634.
doi: 10.2147/JPR.S126851. eCollection 2017.

A review and survey of policies utilized for interventional pain procedures: a need for consensus

Lynn Kohan  1 , Reza Salajegheh  1 , Robin J Hamill-Ruth  1 , Sandeep Yerra  1 , John Butz  2
Affiliations

A review and survey of policies utilized for interventional pain procedures: a need for consensus

Lynn Kohan et al. J Pain Res. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: NSAIDs and anticoagulants in interventional pain procedures; driver policy in interventional pain procedures; interventional pain procedures policies; steroids in pain procedures.

PubMed Disclaimer

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

References

    1. Narouze S, Benzon HT, Provenzano DA, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med. 2015;40(3):182–212. - PubMed
    1. ASAHQ [webpage on the Internet] Statement on Anesthetic Care During Interventional Pain Procedures for Adults. Committee of Origin. American Society of Anesthesiologists – Standards & Guidelines. Pain Medicine; 2016. [Accessed June 8, 2016]. Available from: https://www.asahq.org/quality-and-practice-management/standards-and-guid....
    1. Apfelbaum JL, Silverstein JH, Chung FF, et al. American Society of Anesthesiologists Task Force on Postanesthetic Care Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology. 2013;118(2):291–307. - PubMed
    1. Kennedy D, Schneider BJ, Casey EK, Rittenberg JD, Lento PH, Smuck M. Vasovagal rates in fluoroscopically guided interventional procedures: a study of over 8,000 injections. Pain Med. 2013;14(12):1854–1859. - PMC - PubMed
    1. ASAHQ Statement on Anesthetic Care during Interventional Pain. [Accessed August 13, 2016]. (n.d.). Available from: http://www.asahq.org/~/media/Sites/ASAHQ/Files/Public/Resources/standard....

LinkOut - more resources