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10. More Than a Perioperative Surgical Home: An Opportunity for Anesthesiologists to Advance Public Health.

Author

Coffman, Clarity R., Leng, Jody C., Ye, Ying, Hunter, Oluwatobi O., Walters, Tessa L., Wang, Rachel, Wong, Jimmy K., Mudumbai, Seshadri C., and Mariano, Edward R.

Abstract

Public health and the medical specialty of anesthesiology have been closely intertwined throughout history, dating back to the 1800s when Dr. John Snow used contact tracing methods to identify the Broad Street Pump as the source of a cholera outbreak in London. During the COVID-19 pandemic, leaders in anesthesiology and anesthesia patient safety came forward to develop swift recommendations in the face of rapidly changing evidence to help protect patients and healthcare workers. While these high-profile examples may seem like uncommon events, there are many common modern-day public health issues that regularly intersect with anesthesiology and surgery. These include, but are not limited to, smoking; chronic opioid use and opioid use disorder; and obstructive sleep apnea. As an evolving medical specialty that encompasses pre- and postoperative care and acute and chronic pain management, anesthesiologists are uniquely positioned to improve patient care and outcomes and promote long-lasting behavioral changes to improve overall health. In this article, we make the case for advancing the role of the anesthesiologist beyond the original perioperative surgical home model into promoting public health initiatives within the perioperative period. [ABSTRACT FROM AUTHOR]

Published
2023
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12. A pilot study to assess adductor canal catheter tip migration in a cadaver model

Author

Leng, Jody C., Harrison, T. Kyle, Miller, Brett, Howard, Steven K., Conroy, Myles, Udani, Ankeet, Shum, Cynthia, and Mariano, Edward R.

Subjects
Catheterization -- Models -- Research, Nerve block -- Research -- Risk factors, Pain management -- Research, Health
Abstract

An adductor canal catheter may facilitate early ambulation after total knee arthroplasty, but there is concern over preoperative placement since intraoperative migration of catheters may occur from surgical manipulation and result in ineffective analgesia. We hypothesized that catheter type and subcutaneous tunneling may influence tip migration for preoperatively inserted adductor canal catheters. In a male unembalmed human cadaver, 20 catheter insertion trials were divided randomly into one of four groups: flexible epidural catheter either tunneled or not tunneled; or rigid stimulating catheter either tunneled or not tunneled. Intraoperative patient manipulation was simulated by five range-of-motion exercises of the knee. Distance and length measurements were performed by a blinded regional anesthesiologist. Changes in catheter tip to nerve distance (p = 0.225) and length of catheter within the adductor canal (p = 0.467) were not different between the four groups. Two of five non-tunneled stimulating catheters (40 %) were dislodged compared to 0/5 in all other groups (p = 0.187). A cadaver model may be useful for assessing migration of regional anesthesia catheters; catheter type and subcutaneous tunneling may not affect migration of adductor canal catheters based on this preliminary study. However, future studies involving a larger sample size, actual patients, and other catheter types are warranted., Author(s): Jody C. Leng[sup.1] , T. Kyle Harrison[sup.1] [sup.2] , Brett Miller[sup.3] , Steven K. Howard[sup.1] [sup.2] , Myles Conroy[sup.4] , Ankeet Udani[sup.1] , Cynthia Shum[sup.2] , Edward R. Mariano[sup.1] [...]

Published
2015
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13. 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

14. Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project.

Author

UCL - SSS/IONS/NEUR - Clinical Neuroscience, UCL - (SLuc) Service d'anesthésiologie, 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, 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, UCL - SSS/IONS/NEUR - Clinical Neuroscience, UCL - (SLuc) Service d'anesthésiologie, 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, 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

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. 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. 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. By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia.

Published
2022

15. Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Author

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, 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, and School of Medicine

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

16. Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Author

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

Published
2022
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18. Five-year follow-up to assess long-term sustainability of changing clinical practice regarding anesthesia and regional analgesia for lower extremity arthroplasty

Author

Tamboli, Mallika, primary, Leng, Jody C., additional, Hunter, Oluwatobi O., additional, Kou, Alex, additional, Mudumbai, Seshadri C., additional, Memtsoudis, Stavros G., additional, Walters, Tessa L., additional, Lochbaum, Gregory Milo, additional, and Mariano, Edward R., additional

Published
2020
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19. Replacement of Fascia Iliaca Catheters with Continuous Erector Spinae Plane Blocks Within a Clinical Pathway Facilitates Early Ambulation After Total Hip Arthroplasty

Author

Xu, Lei, primary, Leng, Jody C, additional, Elsharkawy, Hesham, additional, Hunter, Oluwatobi O, additional, Harrison, T Kyle, additional, Vokach-Brodsky, Lindsey, additional, Kumar, Gunjan, additional, Funck, Natasha, additional, Hill, Jonay N, additional, Giori, Nicholas J, additional, Indelli, Pier F, additional, Kou, Alex, additional, and Mariano, Edward R, additional

Published
2020
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21. Five-year follow-up to assess longterm sustainability of changing clinical practice regarding anesthesia and regional analgesia for lower extremity arthroplasty.

Author

Tamboli, Mallika, Leng, Jody C., Hunter, Oluwatobi O., Kou, Alex, Mudumbai, Seshadri C., Memtsoudis, Stavros G., Walters, Tessa L., Lochbaum, Gregory Milo, and Mariano, Edward R.

Subjects
*CONDUCTION anesthesia, *LEG, *TOTAL hip replacement, *SPINAL anesthesia, *TOTAL knee replacement
Abstract

Background: Long-term and sustainable clinical practice changes in anesthesia procedures have not previously been reported. Therefore, we performed a 5-year audit following implementation of a clinical pathway change favoring spinal anesthesia for total knee arthroplasty (TKA). We similarly evaluated a parallel cohort of patients undergoing total hip arthroplasty (THA), who did not undergo a clinical pathway change, and studied utilization rates of continuous peripheral nerve block (CPNB). Methods: We identified all primary unilateral TKA and THA cases completed from January 2013 through December 2018, thereby including clinical pathway change data from one-year pre-implementation to 5-years post-implementation. Our primary outcome was the overall application rate of spinal anesthesia. Secondary outcomes included CPNB utilization rate, 30-day postoperative complications, and resource utilization variables such as hospital readmission, emergency department visits, and blood transfusions. Results: The sample included 1,859 cases, consisting of 1,250 TKAs and 609 THAs. During the initial year post-implementation, 174/221 (78.7%) TKAs received spinal anesthesia compared to 23/186 (12.4%) cases the year before implementation (P < 0.001). During the following 4-year period, 647/843 (77.2%) TKAs received spinal anesthesia (P = 0.532 vs. year 1). The number of THA cases receiving spinal anesthesia the year after implementation was 78/124 (62.9%), compared to 48/116 (41.4%) pre-implementation (P = 0.001); however, the rate decreased over the following 4-year period to 193/369 (52.3%) (P = 0.040 vs. year 1). CPNB use was high in both TKA and THA patient groups, and there were no differences in 30-day postoperative complications, hospital readmission, emergency department visits, or blood transfusions between patients who underwent spinal and general anesthesia in both TKA and THA groups. Conclusions: A clinical pathway change promoting spinal anesthesia for TKA can be effectively implemented and sustained over a 5-year period. [ABSTRACT FROM AUTHOR]

Published
2020
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28. 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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