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

Authors Kohan L, Salajegheh R, Hamill-Ruth RJ, Yerra S, Butz J

Received 6 November 2016

Accepted for publication 5 February 2017

Published 17 March 2017 Volume 2017:10 Pages 625—634

DOI https://doi.org/10.2147/JPR.S126851

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Michael Schatman

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

1Department of Anesthesiology, University of Virginia, Charlottesville, VA, 2West River Anesthesiology Consultants, Rapid City, SD, USA

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: interventional pain procedures policies, steroids in pain procedures, driver policy in interventional pain procedures, NSAIDs and anticoagulants in interventional pain procedures

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