Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.04.015
Brazilian Journal of Anesthesiology
Systematic Review

SBA 2020: Regional anesthesia safety recommendations update

SBA 2020: Atualização das recomendações para segurança em anestesia regional

Liana Maria Tôrres de Araújo Azi, Neuber Martins Fonseca, Livia Gurgel Linard

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Abstract

The purpose of the Brazilian Society of Anesthesiology’s Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.

Keywords

Regional anesthesia;  Infection;  Patient safety

Resumo

O propósito desta atualização das Recomendações da Sociedade Brasileira de Anestesiologia para Segurança em Anestesia Regional foi apresentar novas diretrizes com base na relevância e atualidade clínica nos aspectos de segurança relacionados a analgesia e anestesia regional. Este artigo visa prover uma visão ampla sobre o conhecimento atual no tocante a assepsia e antissepsia pré-procedimento, fatores de risco, diagnóstico e tratamento das complicações infecciosas decorrentes das técnicas anestésicas. Também visa esclarecer sobre o uso de materiais reprocessados na prática da anestesia regional, estabelecer as implicações no manejo asséptico de frascos e ampolas e elucidar sobre a relação custo-efetividade no preparo de soluções a serem administradas continuamente em bloqueios regionais. As bases de dados eletrônicas foram pesquisadas entre Janeiro de 2011 (final da pesquisa de literatura das diretrizes anteriores da SBA sobre segurança em anestesia regional) e Setembro de 2019. Um total de 712 artigos foram encontrados, dos quais 201 foram incluídos para análise posterior e 82 novos estudos foram acrescentados nesta revisão. O sistema de Avaliação, Desenvolvimento e Avaliação da Classificação das Recomendações (GRADE) foi utilizado para avaliar a qualidade do estudo individual e classificar a força da evidência. Esta revisão foi elaborada por membros da Comissão de Normas Técnicas da SBA.

Palavras-chave

Anestesia regional;  Infecção;  Segurança do paciente

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134 K. Roth, P. Heeg, R. Reichl Specific hygiene issues relating to reprocessing and reuse of single- use devices for laparoscopic surgery Surg Endosc., 16 (2002), pp. 1091-1097

135 RDC nº 156, de 11 de agosto de 2006. Dispõe sobre o registro, rotulagem e reprocessamento de produtos médicos, e dá outras providências. https://www20.anvisa.gov.br/segurancadopaciente/index.php/legislacao/category/outras-4. [Acessado em agosto de 2019].

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140 Formulário de Erro de Medicação. Ministério da Saúde. http://portal.anvisa.gov.br/resultado-de-busca?p_p_id=101&p_p_lifecycle=0&p_p_state=maximized&p_p_mode=view&p_p_col_id=column-1&p_p_col_count=1&_101_struts_action=%2Fasset_publisher%2Fview_content&_101_assetEntryId=402388&_101_type=content&_101_groupId=33868&_101_urlTitle=informe-snvs-anvisa-gfarm-n-2-de-16-de-abril-de-2007&redirect=http%3A%2F%2Fportal.anvisa.gov.br%2Fresultado-de-busca%3Fp_p_id=3%26p_p_lifecycle=0%26p_p_state=normal%26p_p_mode=view%26p_p_col_id=column-1%26p_p_col_count=1%26_3_groupId=0%26_3_keywords=Formul%25C3%25A1rio+de+Erro+de+Medica%25C3%25A7%25C3%25A3o%26_3_cur=1%26_3_struts_action=%252Fsearch%252Fsearch%26_3_format=%26_3_formDate=1441824476958&inheritRedirect=true. [Acessado em 22 de agosto de 2018].

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145 T.G. Short, A. O’Regan, J. Lew, et al. Critical incident reporting in an anaesthetic department quality assurance programme Anaesthesia., 48 (1993), pp. 3-7

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151 C.J. Hemingway, S. Malhotra, M. Almeida, et al. The effect of alcohol swabs and filter straws on reducing contamination of glass ampoules used for neuroaxial injections Anaesthesia., 62 (2007), pp. 286-288

152 S. Merriman, M.J. Paech, A.D. Keil Bacterial contamination in solution aspirated from non-sterile packaged fentanyl ampoules Anaesth Intensive Care., 37 (2009), pp. 608-612

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155 S. Head, F.K. Enneking Infusate contamination in regional anesthesia: What every anesthesiologist should know Anesth Analg., 107 (2008), pp. 1412-1418

156 F.B. Sevarino, C.W. Pizarro, R. Sinatra Sterility of epidural solutions – recommendations for cost- effective use Reg Anesth Pain Med., 25 (2000), pp. 368-371

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162 Jm. Neal Ultrasound-Guided Regional Anesthesia and Patient Safety: Update of an Evidence- Based Analysis Reg Anesth Pain Med, 41 (2016), pp. 195-204

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164 H. Bouaziz, F. Aubrun, A. Belbachir, et al. Ultrasound-guided regional anesthesia Ann Fr Anesth Reanim., 32 (2013), pp. 119-120

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Submitted date:
05/08/2019

Accepted date:
02/08/2020

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