Practice advisory on the bleeding risks for peripheral nerve and interfascial plane blockade: evidence review and expert consensus

Abstract

The risk of bleeding complications during regional anesthesia procedures is a significant patient safety consideration. Nevertheless, existing literature provides limited guidance on the stratification of bleeding risk for peripheral nerve and newly described interfascial plane blocks. Our objective was to produce an evidencebased consensus advisory that classifies bleeding risks in This article is accompanied by an editorial.

In reply: Practice advisory on the bleeding risks for peripheral nerve and interfascial blockade: rooted in evidence

“…2 While we may disagree on some points, we share the goal of furthering our understanding of the bleeding risks associated with peripheral regional anesthetic techniques. We believe strongly that scientific discourse, such as that exemplified by the advisory of Tsui et al 3 and our accompanying editorial, 2 is crucial to developing perspective when addressing difficult clinical questions plagued by sparse data. Nevertheless, when creating guidelines, it is important to neither undervalue limited data nor overvalue expert opinion or new suggestions that are derived from invalidated methodologies.…”

Practice advisory on the bleeding risks for peripheral nerve and interfascial blockade: going out on a limb

“…Indeed, cases of clinically relevant bleeding associated with non-neuraxial techniques often present with signs and symptoms of significant blood loss rather than neurologic deficits. 1 In this issue, Tsui et al 3 present a practice advisory sponsored by the Regional Anesthesia and Acute Pain Section of the Canadian Anesthesiologists Society addressing the bleeding risks associated with plexus, peripheral, and interfascial plane blockade. The authors, all highly respected regional anesthesiologists, are to be commended for their exhaustive review of the literature and cataloguing of bleeding complications following traditional, and more recently described, regional anesthesia and acute pain analgesic techniques.…”

“…1 Dans ce numéro du Journal, Tsui et coll. 3 Les recommandations de Tsui et coll. concernant le risque de saignement se fondaient sur -en ordre de priorité -les données probantes dans la littérature, un score de risque de saignement, et l'opinion consensuelle des chercheurs.…”

In reply: erector spinae plane continuous blocks for pediatric liver transplantation

“…Specific best-evidence guidelines2 are employed to reduce hematoma risk that is likely similar to that of surgical drains or central lines and occurs at site that is readily compressible. The relative safety of erector spinae plane (ESP) block is highlighted by a recent advisory4 on bleeding risk describing ESP as low-risk block. We disagree with the use of quadratus lumborum (QL) and transervous abdominis plane blocks for comparison as both are described as intermediate risk by the same advisory4 with a ‘genuine risk of bleeding’.…”

“…The relative safety of erector spinae plane (ESP) block is highlighted by a recent advisory4 on bleeding risk describing ESP as low-risk block. We disagree with the use of quadratus lumborum (QL) and transervous abdominis plane blocks for comparison as both are described as intermediate risk by the same advisory4 with a ‘genuine risk of bleeding’. Our group will often discuss hematoma when offering a QL.…”