Guidelines for the safe clinical practice of peripheral nerve blocks in the adult patient

Self Cite

Peripheral nerve blocks (PNBs) for hip fractures are standard of care in many countries at the emergency department and sometimes even in the prehospital setting. This type of analgesic care is however not standard in Belgium. The structural implementation of PNBs at the emergency department depends on the availability of personnel trained in regional anesthesia and a correct informed consent. Given the professionalization of emergency medicine in Belgium since 2005, anesthesiologists have become less involved in most emergency departments. This might cause a potential lack of personnel trained in regional anesthesia. In this article the authors propose a practical guideline with a decision tree to guide better analgesic care for patients with hip fractures in Belgium.

Section: Contraindications and Risksmentioning

confidence: 99%

Clinical guideline for the use of peripheral nerve block in hip fractures at the emergency department in Belgium

Proesmans,

Vermeylen,

Olyslaegers

et al. 2024

Self Cite

“…In contrast, the Belgian Association for Regional Anesthesia (BARA) guidelines do recommend barrier precautions for the practice of nerve blocks, and the anesthesiologist should wear a surgical mask, surgical cap, and sterile gloves, and disinfect the insertion site with chlorhexidine 0.5% 28 . If a catheter insertion technique is planned, the use of a sterile gown and drapes, and a transducer cover is additionally recommended.…”

Section: Hand Hygiene Remains Important As Its Role In Infection Tran...mentioning

confidence: 99%

“…However, as mentioned before, it is impossible to reliably prevent such contact during ultrasound-guided nerve block or peripheral vascular access, and, therefore, a transducer cover should always be used during these procedures. Third, BARA guidelines do not exist for ultrasoundguided peripheral vascular access, and European recommendations (ERPIUP consensus) do not specifically address ultrasound-guided peripheral vascular access, however, they recommend applying full sterile precautions whenever inserting peripheral cannulas longer than 5 cm, whether or not under ultrasound-guidance 28 . The DEGUM guidelines, on the other hand, recommend using germ-free (non-sterile) gloves and a sterile coupling medium for peripheral vascular access when using the "aseptic no touch" technique.…”

Section: Barrier Precautionsmentioning

confidence: 99%

Review of strategies to prevent infections related to ultrasound-guided nerve blocks and vascular access

Eyssen,

Cops,

Hadzic

2023

Ultrasound guidance has become ubiquitous in the clinical practice of regional anesthesia and vascular access. Because the ultrasound transducer and an acoustic coupling medium (e.g. ultrasound gel) are applied directly to the patient’s body, the contact of a non-sterile ultrasound transducer with the site of intervention during the breach of the skin integrity by the needle carries the risk of infection transmission. Surprisingly, however, recommendations on how to prevent ultrasound-related outbreaks are often conflicting. With the increasing use of ultrasound in interventional procedures, such as vascular access, regional anesthesia, and pain medicine, the development of clear guidelines on how to prevent infection from patient to patient is essential for patient and operator safety. This review aims to provide a current understanding of the mechanisms and prevalence of infection transmission and to summarize the current recommendations for infectious precautions with interventional ultrasound. We also provide practically implementable and pragmatic recommendations for infectious precautions, based on the available information.

“…Nevertheless, PNBs cause minor-tosevere adverse events. Universal and ambulatoryspecific guidelines recommend postoperative follow-up services (POFS) to prevent or timely treat adverse events [8][9][10][11] . Because of its similarity to inpatient recovery, recommendations for follow-up in ambulatory PACUs are well documented.…”

Section: Ethical Approvalmentioning

confidence: 99%

“…There is insufficient evidence to make recommendations on the form of phase 3 follow-up. Several guidelines advise a next-day telephone call, but the practice differs in each center 8,10,11,15 .…”

Section: Ethical Approvalmentioning

confidence: 99%

Safety and follow-up systems after ambulatory peripheral nerve block: a narrative review

Gille,

Vermeulen,

Teunkens

2022

Background: Ambulatory surgery has grown during the last decades, and Peripheral Nerve Blocks (PNB) are widely used for perioperative and postoperative pain management. Follow-up is required during all stages of recovery to assess adverse events. Patients are usually discharged before PNB effects have worn off, but next-day follow-up allows the detection of adverse events. Digital systems are used for different follow-up services, but knowledge is lacking in their use for PNB follow-up. Objective: This narrative review describes PNB-related adverse events and current ambulatory surgery follow-up practices during all recovery stages. Furthermore, this review will evaluate the methods used for PNB follow-up. Methods: A literature search was performed using SCOPUS, Embase, and MEDLINE databases from the earliest record to 01-03-2022. Articles were included if they assessed PNB-related adverse events, follow-up services for ambulatory surgery and PNBs, and outcomes for ambulatory surgery and PNBs. Articles were excluded if they studied non-surgical patients, were inaccessible or contained comments or letters. Results: 67 articles were included after screening. Three postoperative phases are described. Phase 1 encompasses the post-anesthetic care unit (PACU) stay. Phase 2 covers the time from PACU discharge to hospital discharge, and phase 3 starts after hospital discharge. The review shows that follow-up is provided adequately during the postoperative phases 1 and 2, but phase 3 lacks a proper follow-up. Possible complications for PNBs include pain, nausea and vomiting, dyspnea, neurological damage, and infection should be routinely evaluated postoperatively, preferably the day after discharge. Postoperative follow-up is often provided using a telephone call, but a lost-to-follow-up rate of up to 50% is described. Follow-up rates can be improved using digital follow-up systems, including automatic text messages and applications. Video consultations can be used to evaluate these complications. Conclusion: PNB postoperative follow-up after discharge is not well-provided. Telephone follow-up of PNB has a poor response. Digital follow-up systems, like automatic text messages and applications, can increase follow-up rates. Therefore, we recommend application-based follow-up systems. However, additional studies should evaluate the effect on patient outcomes.