ASRA Pain Medicine issues recommendations in light of contrast shortage

Editor's Note

The American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) developed and published on May 23 recommendations clinicians should take during the current shortage of the iodinated contrast medium (ICM) iohexol.

Contrast medium, according to ASRA Pain Medicine, is used to confirm accurate needle placement and injectate delivery, and to exclude the flow of off-target tissue in interventional pain procedures. Currently, iohexol is unavailable or in limited supply due to a shutdown of a production facility in Shanghai, China.

“This shutdown led to a significant supply chain error where people were trying to order their usual amount of stock for their patients and were seeing that their orders weren't being fulfilled,” anesthesiologist and pain medicine physician David Dickerson, MD, told OR Manager. Dickerson is the chair of the American Society of Anesthesiologists’ Committee on Pain Medicine. He, the president of ASRA Pain Medicine, and several others who work together on a multidisciplinary pain working group came together to create and distribute this guidance.

The following are the general recommendations that organizations and healthcare systems should provide to clinicians during the shortage:

• Attempts should be made to risk stratify procedures that can be delayed until the supply resumes.
• Consider alternative forms of visualization (ie, ultrasound).
• If contrast medium is deemed necessary, utilize the lowest possible effective dose based on current guidelines.
• The use of gadolinium can be considered in non-neuraxial injections.
• Lumbar interlaminar epidural injections, sacroiliac and facet joint injections, lumbar medial branch blocks, and radiofrequency denervation can be performed without contrast.

“Every attempt to conserve contrast for clinically appropriate interventions should be made,” ASRA Pain Medicine urged.

More information from Dr Dickerson on this ICM shortage will be published on the July issue of OR Manager.