Regional anesthesia has seen a resurgence in recent years. The introduction of new potent antiplatelet agents, an aging population, and increasing prevalence of cardiovascular disease has led to an increase in the number of patients on anticoagulant medications. One of the greatest fears of regional anesthesia is the development of a neuraxial hematoma, which has been shown to be a high risk for patients on anticoagulant medicines who receive neuraxial anesthesia.(3)
The American Society of Regional Anesthesia and Pain Medicine (ASRA) developed an advisory statement for the use of regional or spinal anesthesia in the context of anticoagulation, for which the 3rd edition was released in 2010, establishing guidelines for the usage of these anesthetics for patients taking a variety of different anticoagulants.
Using the guidelines for anticoagulation as well as for several other patient safety issues, ASRA collaborated with the Vanderbilt University Department of Anesthesiology to develop several mobile device applications with the intention of improving patient safety. There are currently four apps from ASRA: COAGS, LAST, Timeout, and COAGS Pain. All of these apps were built using the most updated guidelines for the subject matters covered, and release app updates with the publishing of new guidelines or data. These apps are easy to purchase and download (https://www.asra.com/page/150/asraapps).
A simple search for “ASRA” will pull up all available apps. Descriptions and prices of each of these apps follow.
ASRA COAGS (Both Regional and Chronic Pain $3.99 each)
The Regional COAGS app is based on the 2010 ASRA guidelines for the use of regional anesthesia in the context of anticoagulation or thrombolysis. This app is constantly updated with new recommendations, and has just been updated to reflect interim draft recommendations for Heparin SQ BID and TID, Enoxaparin SQ QD and BID, and others. The interface is fashioned in a way that makes it easy to quickly search for drugs by brand or generic name.
Once the drug has been selected, you are given the option to select the type of block (neuraxial vs deep plexus vs superficial peripheral). Afterwards, the desired intervention (e.g. placing a block vs. removing a catheter) is selected. The app gives you information regarding how much time after discontinuing the medication should the drug or intervention be pursued, most recent literature in regards to risk of the procedure, and the date that the information was updated. In addition, there is a simple link that enables you to pull up the full 2010 guidelines should you desire to do so. A recent publication shows this app has been downloaded over 8000 times.(4)
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The Chronic Pain COAGS app is based on the 2015 guidelines for interventional spine and pain procedures in the context of anticoagulation. This app is very similar to the Regional version, and allows the user to review each drug in light of the desired intervention.
With the emergence of newer anticoagulant medications, the use of these apps has allowed for better dissemination of established practice guidelines to anesthesiologists.
ASRA Timeout ($1.99)
This app is based on the 2014 ASRA publication(5) on checklists for performing regional nerve blocks. The app gives the health care provider an interactive checklist that is tailored to each block site and accounts for multiple block sites. Once the appropriate steps have been taken, the app will notify the user that it is now appropriate to proceed with the block. It also allows for easy access to the full 2014 ASRA publication if the user so desires. The anticoagulation check also links to the ASRA COAGS function.
ASRA LAST ($3.99)
The ASRA LAST app is an algorithm to follow in cases of suspected local anesthetic systemic toxicity. The user is able to get a calculation of dosing for lipid emulsion based on patient’s weight. ACLS protocols, including pulseless and pulsatile differential pathways can be accessed in real time. They also include the ability to generate a report of all the timed events during the use of the app that can be saved for debriefing purposes, and can be forwarded to www.lipidrescue.org if the user chooses to. (Figure1)
ASRA App Bundle ($7.99)
The ASRA app bundle offers all three of the above apps for a discounted purchase price.
Effective use of apps such as the above can help us improve patient safety.
Figure 1
References
- Chase J. IPads and other drugs. Medical Marketing & Media: The Interactive Guide 2013: 10–11.
- Clinician use of a palmtop drug reference guide. J
Am Med Inform Assoc 2002 May-Jun; 9: 223-9. - Horlocker TT, Wedel DJ. Neuraxial block
and low-molecular-weight heparin: balancing
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Reg Anesth Pain Med 1998; 23: 164-177. - Gupta RK, McEvoy MD. Initial Experience of the
American Society of Regional Anesthesia and Pain
Medicine Coags Regional Smartphone Application A
Novel Report of Global Distribution and Clinical Usage
of an Electronic Decision Support Tool to Enhance Guideline Use Reg Anesth Pain Med 2016; 41: 334–338. - Mulroy MF, Weller RS, Liguori GA. A checklist
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