Table 2 Summary table

1

Is it safe to perform a central neuraxial block in patients on cardioaspirin therapy?

In adult patients on cardioaspirin therapy undergoing RA with neuraxial block, it is recommended to continue cardioaspirin administration, as it does not increase the incidence of spinal hematomas

Low

2

Does the combined use of ultrasound and nerve stimulation (ENS) in peripheral nerve blocks with a motor component in adult patients increase the efficacy and safety of surgical blocks, reducing neurological complications and nerve damage?

In adult patients undergoing medical procedures requiring RA, the use of dual guidance compared to ENS-only guidance in peripheral nerve blocks with a motor component is recommended, as it reduces the risk of serious neurological complications and/or nerve damage

Moderate

3

Is the use of ultrasound-guided peripheral block techniques safe in adult patients taking direct oral anticoagulants (DOAC)?

In adult patients taking DOACs, it is suggested to use ultrasound-guided peripheral nerve blocks, as it is safe and does not increase hemorrhagic complications

Low

4

Can the use of ultrasound-guided techniques increase safety in nerve block procedures in adult patients?

In adult patients, the use of ultrasound-guided techniques for the performance of peripheral nerve blocks is suggested, as it ensures the safety of the procedure and reduces the risk of complications compared to nerve blocks without ultrasound guidance

Moderate

5

Can a sterile surgical field (using disinfectants, covers, gloves, and sterile drapes) set up for the execution of neuraxial techniques, help reduce the occurrence of infections related to the technique itself?

In adult patients undergoing epidural anesthesia, the preparation of a sterile surgical field (using antiseptic, covers, gloves, drapes, and mask) is suggested to ensure patient safety

Low

6

Can a sterile surgical field setup (using disinfectants, covers, gloves, and sterile drapes) for the execution of continuous peripheral regional anesthesia techniques help reduce the development of infections related to the procedure itself?

In adult patients undergoing continuous peripheral regional anesthesia techniques, the preparation of a sterile surgical field (using disinfectant, covers, gloves, drapes, and mask) for the procedure is suggested to reduce the occurrence of infections and ensure patient and procedural safety

Low

No

PICO

Good practice statement

7

Is the use of antiplatelet drugs safe for patients undergoing a dual guidance peripheral nerve block?

7.1 Superficial peripheral blocks are considered safe in patients on antiplatelet therapy regardless of the dosage or the drug taken

7.2 For deep peripheral nerve blocks in patients undergoing antiplatelet therapy, the same recommendations as neuraxial procedures should be followed regarding the suspension timing of antiplatelet drugs

8

Is it safe to perform peripheral nerve block techniques with dual guidance in adult patients on anticoagulant therapy?

8.1 The expert panel suggests that whenever possible, an appropriate suspension period for anticoagulant medications is always preferable for both deep and superficial peripheral nerve blocks

8.2 The expert panel suggests that deep peripheral nerve blocks (such as lumbar plexus block) are high-risk procedures for bleeding, and, therefore, in the absence of an adequate suspension period from anticoagulant medications, these blocks cannot be performed safely

8.3 The expert panel suggests that superficial peripheral nerve blocks can be performed safely in adult patients receiving anticoagulants, even if these medications cannot be suspended

8.4 The expert panel suggests that the use of dual guidance, compared to not using it, should not influence the anticoagulant suspension time, as there is no evidence that the use of dual guidance is able to reduce hemorrhagic complications in anticoagulated patients

8.5 The expert panel suggests that all recommendations, precautions, and prescriptions outlined in international guidelines applied to nonurgent cases should be followed also in urgent and emergency situations

9

Can the use of infusion pressure monitoring techniques, during the performance of peripheral blocks, reduce the onset of neurological complications in adult patients undergoing RA techniques?

9.1 The multidisciplinary expert panel believes that performing peripheral blocks with infusion pressure monitoring techniques does not reduce occurrence of neurological complications in adult patients undergoing RA techniques

10

Can the preparation of a sterile surgical field (disinfectant, probe covers, gloves, and drapes) for the performance of single-shot peripheral regional anesthesia techniques help reduce the incidence of infections related to the technique itself?

10.1 The multidisciplinary expert panel suggests that performing single-shot peripheral regional anesthesia techniques, skin disinfection with 2% chlorhexidine in alcoholic solution, the use of a single-use probe cover, and a no-touch technique are sufficient to reduce the incidence of infections related to the technique itself

11

Which are the post-procedural monitoring tools for patients undergoing regional anesthesia techniques?

11.1 The multidisciplinary expert panel suggests that patients undergoing subarachnoid and epidural anesthesia should always be clinically reassessed before discharge from the surgical ward. The evaluation should include oxygen saturation, blood pressure, and heart rate. Discharge should only occur after a regression of the sensory block of at least two dermatomes and, in any case, below the T12 dermatome. If intrathecal or epidural opioid is deemed appropriate, it is recommended that the patient’s vital parameters be monitored for at least 30 min before discharge from the surgical ward

11.2 The multidisciplinary expert panel suggests that patient monitoring should not be limited to the surgical ward (operating room and recovery room) but should be a continuous process within the hospital ward, as even severe complications such as neuraxial hematomas can manifest lately. Therefore, it is important to ensure careful neurological surveillance, closely monitoring patients with prolonged sensory and/or motor blocks beyond the expected duration or a recurrence of sensory and/or motor blocks after initial regression