Peri-procedural protocols for interventional pain management techniques: a survey of US pain centers.
BACKGROUND
Interventional techniques are now an integral part of chronic pain management. As new procedures are arising at a rapid pace, decisions regarding patient safety and comfort are becoming more challenging. No peri-procedural consensus protocol currently addresses issues such as 1. nulla per os (NPO) status, 2. sedation, 3. monitoring, or 4. recovery. In establishing safety guidelines for interventional pain procedures, the knowledge of current peri-procedural protocols is required.


OBJECTIVE
To survey interventional pain practices and to obtain current peri-procedural protocols.


METHODS
We faxed a one-page questionnaire to 105 United States pain practices identified using the directory of the American Pain Society. Fifty-seven academic and private pain practices (54%) responded and were included in the analysis.


RESULTS
Monitoring devices such as electrocardiogram (EKG), blood pressure, and pulse oximetry are not universally employed for cervical or lumbar spinal procedures. Even procedures that are often performed by anesthesiologists in operating rooms, such as Bier blocks, are not monitored in a uniform manner when performed in pain clinics. Establishment of intravenous access for procedures also varies among practitioners. Most (72%) practices had treated patients with vasovagal reactions over the past 12 months, but only 42% had simulated cardiac arrests to prepare for these situations.


CONCLUSIONS
While various trends in peri-procedural care are observable, standards of care are not well established. In order to minimize complications associated with interventional pain management techniques, the pain management community should agree on safety guidelines for all procedures, much as these advocated by the American Society of Anesthesiology for surgical anesthetic care.
Ahmed
Shihab U
SU
Massachusetts General Hospital Pain Center, WACC 324, 15 Parkman Street, Boston, MA 021114, USA. shihablincoln@aol.com
Tonidandel
William
W
Trella
Jason
J
Martin
Nicole M
NM
Chang
Yuchiao
Y