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1. Recommendations for anatomical structures to identify on ultrasound for the performance of intermediate and advanced blocks in ultrasound-guided regional anesthesia

Author

Toby Ashken, James Bowness, Alan James Robert Macfarlane, Lloyd Turbitt, Boyne Bellew, Nigel Bedforth, David Burckett-St Laurent, Alain Delbos, Kariem El-Boghdadly, Nabil M Elkassabany, Jenny Ferry, Ben Fox, James L H French, Calum Grant, Ashwani Gupta, Rajnish K Gupta, Yavuz Gürkan, Nat Haslam, Helen Higham, Rosemary M G Hogg, David F Johnston, Rachel Joyce Kearns, Clara Lobo, Sonya McKinlay, Edward R Mariano, Stavros Memtsoudis, Peter Merjavy, Madan Narayanan, J Alison Noble, David Phillips, Meg Rosenblatt, Amy Sadler, Maria Paz Sebastian, Eric S Schwenk, Alasdair Taylor, Athmaja Thottungal, Luis Fernando Valdés-Vilches, Thomas Volk, Simeon West, Morné Wolmarans, Jonathan Womack, and Amit Pawa

Subjects
Anesthesiology and Pain Medicine, pain management, lower extremity (regional anesthesia), Anesthesia, Conduction, Humans, ultrasonography, Peripheral Nerves, General Medicine, regional anesthesia, upper extremity (regional anesthesia), Ultrasonography, Interventional, Ultrasonography
Abstract

Recent recommendations describe a set of core anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia (UGRA). This project aimed to generate consensus recommendations for core structures to identify during the performance of intermediate and advanced blocks. An initial longlist of structures was refined by an international panel of key opinion leaders in UGRA over a three-round Delphi process. All rounds were conducted virtually and anonymously. Blocks were considered twice in each round: for “orientation scanning” (the dynamic process of acquiring the final view) and for “block view” (which visualizes the block site and is maintained for needle insertion/injection). A “strong recommendation” was made if ≥75% of participants rated any structure as “definitely include” in any round. A “weak recommendation” was made if >50% of participants rated it as “definitely include” or “probably include” for all rounds, but the criterion for strong recommendation was never met. Structures which did not meet either criterion were excluded. Forty-one participants were invited and 40 accepted; 38 completed all three rounds. Participants considered the ultrasound scanning for 19 peripheral nerve blocks across all three rounds. Two hundred and seventy-four structures were reviewed for both orientation scanning and block view; a “strong recommendation” was made for 60 structures on orientation scanning and 44 on the block view. A “weak recommendation” was made for 107 and 62 structures, respectively. These recommendations are intended to help standardize teaching and research in UGRA and support widespread and consistent practice.

Published
2022
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2. Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Author

Hassan M Ahmed, Benjamin P Atterton, Gillian G Crowe, Jaime L Barratta, Mark Johnson, Eugene Viscusi, Sanjib Adhikary, Eric Albrecht, Karen Boretsky, Jan Boublik, Dara S Breslin, Kelly Byrne, Alan Ch'ng, Alwin Chuan, Patrick Conroy, Craig Daniel, Andrzej Daszkiewicz, Alain Delbos, Dan Sebastian Dirzu, Dmytro Dmytriiev, Paul Fennessy, H Barrie J Fischer, Henry Frizelle, Jeff Gadsden, Philippe Gautier, Rajnish K Gupta, Yavuz Gürkan, Harold David Hardman, William Harrop-Griffiths, Peter Hebbard, Nadia Hernandez, Jakub Hlasny, Gabriella Iohom, Vivian H Y Ip, Christina L Jeng, Rebecca L Johnson, Hari Kalagara, Brian Kinirons, Andrew Kenneth Lansdown, Jody C Leng, Yean Chin Lim, Clara Lobo, Danielle B Ludwin, Alan James Robert Macfarlane, Anthony T Machi, Padraig Mahon, Stephen Mannion, David H McLeod, Peter Merjavy, Aleksejs Miscuks, Christopher H Mitchell, Eleni Moka, Peter Moran, Ann Ngui, Olga C Nin, Brian D O'Donnell, Amit Pawa, Anahi Perlas, Steven Porter, John-Paul Pozek, Humberto C Rebelo, Vicente Roqués, Kristopher M Schroeder, Gary Schwartz, Eric S Schwenk, Luc Sermeus, George Shorten, Karthikeyan Srinivasan, Markus F Stevens, Kassiani Theodoraki, Lloyd R Turbitt, Luis Fernando Valdés-Vilches, Thomas Volk, Katrina Webster, T Wiesmann, Sylvia H Wilson, Morné Wolmarans, Glenn Woodworth, Andrew K Worek, E M Louise Moran, Gürkan, Yavuz (ORCID 0000-0002-2307-6943 & YÖK ID 154129), Ahmed, Hassan M., Atterton, Benjamin P., Crowe, Gillian G., Barratta, Jaime L., Johnson, Mark, Viscusi, Eugene, Adhikary, Sanjib, Albrecht, Eric, Boretsky, Karen, Boublik, Jan, Breslin, Dara S., Byrne, Kelly, Ch'ng, Alan, Chuan, Alwin, Conroy, Patrick, Daniel, Craig, Daszkiewicz, Andrzej, Delbos, Alain, Dirzu, Dan Sebastian, Dmytriiev, Dmytro, Fennessy, Paul, Fischer, H. Barrie J., Frizelle, Henry, Gadsden, Jeff, Gautier, Philippe, Gupta, Rajnish K., Hardman, Harold David, Harrop-Griffiths, William, Hebbard, Peter, Hernandez, Nadia, Hlasny, Jakub, Iohom, Gabriella, Ip, Vivian H. Y., Jeng, Christina L. ., Johnson, Rebecca L., Kalagara, Hari, Kinirons, Brian, Lansdown, Andrew Kenneth, Leng, Jody C., Lim, Yean Chin, Lobo, Clara, Ludwin, Danielle B., Macfarlane, Alan James Robert, Machi, Anthony T., Mahon, Padraig, Mannion, Stephen, McLeod, David H., Merjavy, Peter, Miscuks, Aleksejs, Mitchell, Christopher H., Moka, Eleni, Moran, Peter, Ngui, Ann, Nin, Olga C., O'Donnell, Brian D., Pawa, Amit, Perlas, Anahi, Porter, Steven, Pozek, John-Paul, Rebelo, Humberto C., Roques, Vicente, Schroeder, Kristopher M., Schwartz, Gary, Schwenk, Eric S., Sermeus, Luc, Shorten, George, Srinivasan, Karthikeyan, Stevens, Markus F., Theodoraki, Kassiani, Turbitt, Lloyd R., Valdes-Vilches, Luis Fernando, Volk, Thomas, Webster, Katrina, Wiesmann, T., Wilson, Sylvia H., Wolmarans, Morne, Woodworth, Glenn, Worek, Andrew K., Moran, E. M. Louise, Koç University Hospital, School of Medicine, UCL - SSS/IONS/NEUR - Clinical Neuroscience, UCL - (SLuc) Service d'anesthésiologie, Anesthesiology, APH - Quality of Care, and Amsterdam Neuroscience - Neuroinfection & -inflammation

Subjects
Consensus, neuraxial, Delphi Technique, education, General Medicine, Documentation, international consensus, anesthesia, documentation, nerve block, Anesthesiology and Pain Medicine, Anesthesiology, Anesthesia, Conduction, Nerve block, Regional anesthesia, Anesthesia, Neuraxial, Minimum standards, Delphi process, Humans, regional anesthesia, minimum standards
Abstract

Background and objectives: documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. Methods: following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as >= 75% agreement and weak consensus as 50%-74% agreement. Results: seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. Conclusion: by means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia., European Society of Regional Anaesthesia and Pain Therapy (ESRA); ASRA Pain Medicine

Published
2022

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