ASRA Pain Medicine consensus practice infection control guidelines for regional anesthesia and pain medicine

David Anthony Provenzano; Michael Hanes; Christine Hunt; Honorio T Benzon; Jay S Grider; Kelly Cawcutt; Tina L Doshi; Salim Hayek; Bryan Hoeltzer; Rebecca L Johnson; Hari Kalagara; Sandra Kopp; Randy W Loftus; Alan James Robert Macfarlane; Ameet S Nagpal; Stephanie A Neuman; Amit Pawa; Amy C S Pearson; Julie Pilitsis; Eellan Sivanesan; Rakesh V Sondekoppam; Jan Van Zundert; Samer Narouze

doi:10.1136/rapm-2024-105651

ASRA Pain Medicine consensus practice infection control guidelines for regional anesthesia and pain medicine

Reg Anesth Pain Med. 2025 Jan 20:rapm-2024-105651. doi: 10.1136/rapm-2024-105651. Online ahead of print.

Authors

David Anthony Provenzano¹, Michael Hanes², Christine Hunt³, Honorio T Benzon^{4

5}, Jay S Grider⁶, Kelly Cawcutt⁷, Tina L Doshi^{8

9

10}, Salim Hayek^{11

12}, Bryan Hoeltzer¹³, Rebecca L Johnson¹⁴, Hari Kalagara¹⁵, Sandra Kopp¹⁶, Randy W Loftus¹⁴, Alan James Robert Macfarlane^{17

18}, Ameet S Nagpal¹⁹, Stephanie A Neuman²⁰, Amit Pawa^{21

22}, Amy C S Pearson²³, Julie Pilitsis²⁴, Eellan Sivanesan²⁵, Rakesh V Sondekoppam²⁶, Jan Van Zundert^{27

28}, Samer Narouze²⁹

Affiliations

¹ Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, USA davidprovenzano@hotmail.com.
² Jax Spine and Pain Centers, Jacksonville, Florida, USA.
³ Anesthesiology-Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA.
⁴ Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁵ Division of Pain Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA.
⁶ Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, USA.
⁷ Division of Infectious Diseases and Pulmonary & Critical Care Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
⁸ Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
⁹ Division of Pain Medicine, John Hopkins University, Baltimore, Maryland, USA.
¹⁰ Department of Neurosurgery, John Hopkins University, Baltimore, Maryland, USA.
¹¹ Anesthesiology, Case Western Reserve University, Cleveland, Ohio, USA.
¹² University Hospitals of Cleveland, Cleveland, Ohio, USA.
¹³ Southwest Pain & Spine Center, Provo, Utah, USA.
¹⁴ Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
¹⁵ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA.
¹⁶ Anesthesiology, Mayo Clinic Graduate School for Biomedical Sciences, Rochester, Minnesota, USA.
¹⁷ Glasgow Royal Infirmary and Stobhill Ambulatory Hospital, Glasgow, UK.
¹⁸ University of Glasgow, Glasgow, UK.
¹⁹ Department of Orthopaedics and Physical Medicine & Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA.
²⁰ Department of Pain Medicine, Gundersen Health System, La Crosse, Wisconsin, USA.
²¹ Department of Theatres, Anaesthesia and Perioperative Medicine, Guy's and St Thomas' Hospitals NHS Trust, London, UK.
²² King's College London, London, UK.
²³ Anesthesia, Advocate Aurora Health Inc, Milwaukee, Wisconsin, USA.
²⁴ Arizona State University, Tucson, Arizona, USA.
²⁵ Neuromodulation, Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
²⁶ Department of Anesthesia, Pain, and Perioperative Medicine, Stanford University, Palo Alto, California, USA.
²⁷ Anesthesiology and Pain Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.
²⁸ Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium.
²⁹ Division of Pain Management, University Hospitals, Cleveland, Ohio, USA.

PMID: 39837579
DOI: 10.1136/rapm-2024-105651

Abstract

Background: To provide recommendations on risk mitigation, diagnosis and treatment of infectious complications associated with the practice of regional anesthesia, acute and chronic pain management.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: analgesics, opioid; injections, spinal; nerve block; pain management; spinal cord stimulation.