To the Editor

Hebl in 2006 stated in a review article published in Regional Anesthesia and Pain Medicine that chlorhexidine-based solutions should be considered the antiseptic of choice for regional anesthetic procedures and that its use be considered a Grade A recommendation.¹ In a previous APSF Newsletter these solutions have also been recommended, based on effectiveness, for skin preparation prior to insertion of invasive intravascular catheters to reduce the risk of catheter-related bloodstream infections.²

In spite of this, still in 2008 the Chloraprep “One-Step” applicator (Medi-flex, Overland, KS) has written in its contraindications in the back, that this solution should not be used when working in close proximity to meningeal structures.

In my opinion this remains a tremendous problem because we have conflicting data and the clinician remains in the middle unable to convincingly follow the published guidelines from the American Society of Regional Anesthesia and Pain Medicine or follow the recommendations from the manufacturer. So in the context of safety what should we do?

Felipe Urdaneta, MD
Gainesville, FL

References

Hebl JR. The importance and implications of aseptic techniques during regional anesthesia. Reg Anesth Pain Med 2006;31: 311-23.

Wagner CE, Prielipp RC. Chlorhexidine prep decreases catheter-related infections. APSF Newsletter 2003;18:2.