• Tsui Ban C H BCH http://orcid.org/0000-0002-6984-5998 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Med, Kyle Kirkham, M Kwesi Kwofie, Tran De Q Q McGill University, Montreal, QC, Canada., Patrick Wong, Ki Jinn Chin, and Rakesh V Sondekoppam.
• Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, USA. bantsui@stanford.edu.
• Can J Anaesth. 2019 Nov 1; 66 (11): 1356-1384.

AbstractThe 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 evidence-based consensus advisory that classifies bleeding risks in patients undergoing regional peripheral nerve and interfascial plane block procedures. This advisory is intended to facilitate clinical decision-making in conjunction with national or local guidelines and to guide consideration for appropriate alterations to anticoagulation regimens before specific regional anesthesia procedures. In pursuit of this goal, the Regional Anesthesia and Acute Pain Section of the Canadian Anesthesiologists Society (CAS) assembled a panel of seven Canadian experts to classify the risk of bleeding complications associated with regional peripheral nerve and interfascial plane blocks. At the 75th annual meeting of the CAS in June 2018, the panel's expert opinion was finalized and the published literature was quantified within an organized framework. All common peripheral nerve and interfascial plane blocks were categorized into "low risk", "intermediate risk", and "high risk" based on the literature evidence, bleeding risk scores, and consensus opinion (in that order of priority). Clinical data is often limited, so readers of this consensus report should be reminded that these recommendations are mostly based on expert consensus. Hence, this advisory should not to be defined as a standard of care but rather serve as a resource for clinicians assessing the risk and benefits of regional anesthesia in management of their patients.

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