Time to re-evaluate the routine use of sterile gowns in neuraxial anaesthesia

In Australia, sterile gowns are considered an essential component of aseptic technique for all neuraxial procedures. However, guidelines from professional societies vary worldwide, and the Australian and New Zealand College of Anaesthetists' (ANZCA) guidelines are the oldest currently in use. In the USA, Canada and Brazil, gowning is not considered to be a routine requirement when undertaking neuraxial anaesthesia. Recent guidelines published by the Association of Anaesthetists of Great Britain and Ireland (AAGBI; 2020) acknowledge the importance of aseptic technique in central neuraxial blocks, but no longer state that gowning is required (as did the previous version of the guidance). However, AAGBI guidelines do recommend gowning for neuraxial procedures involving immunocompromised patients. The European and American Societies of Regional Anaesthesia (ESRA, ASRA) 2022 practice advisory guidelines recommend gowning for central neuraxial catheter placement in paediatric patients. ASRA guidelines state that routine gowning is not required for adults, and ESRA does not have guidelines relevant to gowning for adult patients. No explanation is given for this difference in recommendations.