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6. Research priorities in regional anaesthesia: an international Delphi study

Author

Ferry, Jenny, Lewis, Owen, Lloyd, James, El-Boghdadly, Kariem, Kearns, Rachel, Albrecht, Eric, Altermatt, Fernando, Ashokka, Balakrishnan, Ayad, Amany E., Aziz, Ezzat S., Aziz, Lutful, Jagannathan, Balavenkatasubramanian, Bouarroudj, Noreddine, Chin, Ki Jinn, Delbos, Alain, de Gracia, Alex, Ip, Vivian H.Y., Kwofie, Kwesi, Layera, Sebastian, Lobo, Clara A., Mohammed, Mohammed, Moka, Eleni, Moreno, Milena, Morgan, Bethan, Polela, Arthur, Rahimzadeh, Poupak, Tangwiwat, Suwimon, Uppal, Vishal, Vaz Perez, Marcelo, Volk, Thomas, Wong, Patrick B.Y., Bowness, James S., and Macfarlane, Alan J.R.

Published
2024
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14. Efficacy and safety of intrathecal diamorphine: a systematic review and meta‐analysis with meta‐regression and trial sequential analysis.

Author

Grape, Sina, El‐Boghdadly, Kariem, Jaques, Cecile, and Albrecht, Eric

Subjects
POSTOPERATIVE nausea & vomiting, HEROIN, SEQUENTIAL analysis, MORPHINE, CONTROL groups
Abstract

Summary: Background: Intrathecal diamorphine is believed to provide postoperative analgesia but is associated with adverse effects such as nausea and vomiting. There is little evidence of synthesis regarding intrathecal diamorphine in the contemporary literature. We performed a systematic review, meta‐analysis with meta‐regression and trial sequential analysis to determine the magnitude of intrathecal diamorphine efficacy and safety. Methods: We systematically searched the literature for trials comparing intrathecal diamorphine with a control group in patients undergoing all types of surgery. The primary efficacy and safety outcomes were intravenous morphine consumption and incidence of postoperative nausea and vomiting at 24 h following surgery, respectively. Results: Twelve trials were identified, which included data for 712 patients. Intrathecal doses of diamorphine ranged from 100 μg to 2500 μg. Intravenous morphine consumption at 24 h postoperatively was significantly reduced in the intrathecal diamorphine group, with a mean difference (95%CI) of ‐8 mg (‐11 to ‐6), I2 = 93%, p < 0.001. There was a significant difference between three intrathecal diamorphine dosing subgroups but without correlation: mean differences (95%CI) ‐1 mg (‐3–0), ‐26 mg (‐40 to ‐11) and ‐6 mg (‐15–4) in patients receiving doses of 0–200 μg, 201–400 μg and > 400 μg, respectively (p = 0.003). Intrathecal diamorphine increased postoperative nausea and vomiting with a risk ratio (95%CI) of 1.37 (1.19–1.58), I2 = 7%, p < 0.001. There were no differences in postoperative nausea and vomiting between the three intrathecal diamorphine dosing subgroups. There was no correlation observed with meta‐regression of the primary efficacy and safety outcomes. The quality of evidence for all outcomes was very low. Conclusion: There is very low level of evidence that intrathecal diamorphine provides effective analgesia after surgery, while increasing postoperative nausea and vomiting with doses > 200 μg. [ABSTRACT FROM AUTHOR]

Published
2024
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21. Single-bolus injection of local anesthetic, with or without continuous infusion, for interscalene brachial plexus block in the setting of multimodal analgesia: a randomized controlled unblinded trial.

Author

Rhyner, Patrick, Cachemaille, Matthieu, Goetti, Patrick, Rossel, Jean-Benoit, Boand, Melanie, Farron, Alain, and Albrecht, Eric

Abstract

Introduction Previous trials favored a continuous interscalene brachial plexus block over a single injection for major shoulder surgery. However, these trials did not administer a multimodal analgesic regimen. This randomized, controlled unblinded trial tested the hypothesis that a continuous infusion of local anesthetic for an interscalene brachial plexus block still provides superior analgesia after major shoulder surgery when compared with a single injection in the setting of multimodal analgesia, inclusive of intravenous dexamethasone, magnesium, acetaminophen and ketorolac. Methods Sixty patients undergoing shoulder arthroplasty or arthroscopic rotator cuff repair were randomized to receive a bolus of ropivacaine 0.5%, 20 mL, with or without a continuous infusion of ropivacaine 0.2% 4-8 mL/hour, for an interscalene brachial plexus block. Patients were provided with intravenous morphine patient-controlled analgesia. The primary outcome was cumulative intravenous morphine consumption at 24 hours postoperatively. Secondary outcomes included pain scores at rest and on movement, and functional outcomes, measured over 48 hours after surgery. Results Median (IQR) cumulative intravenous morphine consumption at 24 hours postoperatively was 10 mg (4-24) in the continuous infusion group and 14 mg (8-26) in the single injection group (p=0.74). No significant between-group differences were found for any of the secondary outcomes. Conclusions A continuous infusion of local anesthetic for an interscalene brachial plexus block does not provide superior analgesia after major shoulder surgery when compared with a single injection in the setting of multimodal analgesia, inclusive of intravenous dexamethasone, magnesium, acetaminophen and ketorolac. The findings of this study are limited by performance and detection biases. [ABSTRACT FROM AUTHOR]

Published
2024
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23. Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks

Author

El-Boghdadly, Kariem, primary, Albrecht, Eric, additional, Wolmarans, Morné, additional, Mariano, Edward R, additional, Kopp, Sandra, additional, Perlas, Anahi, additional, Thottungal, Athmaja, additional, Gadsden, Jeff, additional, Tulgar, Serkan, additional, Adhikary, Sanjib, additional, Aguirre, Jose, additional, Agur, Anne M R, additional, Altıparmak, Başak, additional, Barrington, Michael J, additional, Bedforth, Nigel, additional, Blanco, Rafael, additional, Bloc, Sébastien, additional, Boretsky, Karen, additional, Bowness, James, additional, Breebaart, Margaretha, additional, Burckett-St Laurent, David, additional, Carvalho, Brendan, additional, Chelly, Jacques E, additional, Chin, Ki Jinn, additional, Chuan, Alwin, additional, Coppens, Steve, additional, Costache, Ioana, additional, Dam, Mette, additional, Desmet, Matthias, additional, Dhir, Shalini, additional, Egeler, Christian, additional, Elsharkawy, Hesham, additional, Bendtsen, Thomas Fichtner, additional, Fox, Ben, additional, Franco, Carlo D, additional, Gautier, Philippe Emmanuel, additional, Grant, Stuart Alan, additional, Grape, Sina, additional, Guheen, Carrie, additional, Harbell, Monica W, additional, Hebbard, Peter, additional, Hernandez, Nadia, additional, Hogg, Rosemary M G, additional, Holtz, Margaret, additional, Ihnatsenka, Barys, additional, Ilfeld, Brian M, additional, Ip, Vivian H Y, additional, Johnson, Rebecca L, additional, Kalagara, Hari, additional, Kessler, Paul, additional, Kwofie, M Kwesi, additional, Le-Wendling, Linda, additional, Lirk, Philipp, additional, Lobo, Clara, additional, Ludwin, Danielle, additional, Macfarlane, Alan James Robert, additional, Makris, Alexandros, additional, McCartney, Colin, additional, McDonnell, John, additional, McLeod, Graeme A, additional, Memtsoudis, Stavros G, additional, Merjavy, Peter, additional, Moran, E M Louise, additional, Nader, Antoun, additional, Neal, Joseph M, additional, Niazi, Ahtsham U, additional, Njathi-Ori, Catherine, additional, O'Donnell, Brian D, additional, Oldman, Matt, additional, Orebaugh, Steven L, additional, Parras, Teresa, additional, Pawa, Amit, additional, Peng, Philip, additional, Porter, Steven, additional, Pulos, Bridget P, additional, Sala-Blanch, Xavier, additional, Saporito, Andrea, additional, Sauter, Axel R, additional, Schwenk, Eric S, additional, Sebastian, Maria Paz, additional, Sidhu, Navdeep, additional, Sinha, Sanjay Kumar, additional, Soffin, Ellen M, additional, Stimpson, James, additional, Tang, Raymond, additional, Tsui, Ban C H, additional, Turbitt, Lloyd, additional, Uppal, Vishal, additional, van Geffen, Geert J, additional, Vermeylen, Kris, additional, Vlassakov, Kamen, additional, Volk, Thomas, additional, Xu, Jeff L, additional, and Elkassabany, Nabil M, additional

Published
2023
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48. Core outcome set for peripheral regional anesthesia research: a systematic review and Delphi study

Author

Hill, Jeremy, primary, Ashken, Toby, additional, West, Simeon, additional, Macfarlane, Alan James Robert, additional, El-Boghdadly, Kariem, additional, Albrecht, Eric, additional, Chin, Ki Jinn, additional, Fox, Ben, additional, Gupta, Ashwani, additional, Haskins, Stephen, additional, Haslam, Nat, additional, Hogg, Rosemary MG, additional, Hormis, Anil, additional, Johnston, David F, additional, Mariano, Edward R, additional, Merjavy, Peter, additional, Moll, Timothy, additional, Parry, James, additional, Pawa, Amit, additional, Russon, Kim, additional, Sebastian, Maria Paz, additional, Turbitt, Lloyd, additional, Womack, Jonathan, additional, and Chazapis, Maria, additional

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

Author

Ahmed, Hassan M, Atterton, Benjamin P, Crowe, Gillian G, Barratta, Jaime L, Johnson, Mark, Viscusi, Eugene R., 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, Gürkan, Yavuz, 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, Roqués, Vicente, Schroeder, Kristopher M, Schwartz, Gary, Schwenk, Eric S., Sermeus, Luc, Shorten, George, Srinivasan, Karthikeyan, Stevens, Markus F, Theodoraki, Kassiani, Turbitt, Lloyd R, Valdés-Vilches, Luis Fernando, Volk, Thomas, Webster, Katrina, Wiesmann, T, Wilson, Sylvia H, Wolmarans, Morné, Woodworth, Glenn, Worek, Andrew K, Moran, E M Louise, Ahmed, Hassan M, Atterton, Benjamin P, Crowe, Gillian G, Barratta, Jaime L, Johnson, Mark, Viscusi, Eugene R., 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, Gürkan, Yavuz, 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, Roqués, Vicente, Schroeder, Kristopher M, Schwartz, Gary, Schwenk, Eric S., Sermeus, Luc, Shorten, George, Srinivasan, Karthikeyan, Stevens, Markus F, Theodoraki, Kassiani, Turbitt, Lloyd R, Valdés-Vilches, Luis Fernando, Volk, Thomas, Webster, Katrina, Wiesmann, T, Wilson, Sylvia H, Wolmarans, Morné, Woodworth, Glenn, Worek, Andrew K, and Moran, E M Louise

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.

Published
2022

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