There is no universally agreed set of anatomical structures that must be
identified on ultrasound for the performance of ultrasound-guided regional
anesthesia (UGRA) techniques. This study aimed to produce standardized
recommendations for core (minimum) structures to identify during seven basic
blocks. An international consensus was sought through a modified Delphi
process. A long-list of anatomical structures was refined through serial
review by key opinion leaders in UGRA. All rounds were conducted remotely
and anonymously to facilitate equal contribution of each participant. Blocks
were considered twice in each round: for “orientation scanning” (the dynamic
process of acquiring the final view) and for the “block view” (which
visualizes the block site and is maintained for needle insertion/injection).
Strong recommendations for inclusion were made if ≥75% of participants rated
a structure as “definitely include” in any round. Weak recommendations were
made if >50% of participants rated a structure as “definitely include” or
“probably include” for all rounds (but the criterion for “strong
recommendation” was never met). Thirty-six participants (94.7%) completed
all rounds. 128 structures were reviewed; a “strong recommendation” is made
for 35 structures on orientation scanning and 28 for the block view. A “weak
recommendation” is made for 36 and 20 structures, respectively. This study
provides recommendations on the core (minimum) set of anatomical structures
to identify during ultrasound scanning for seven basic blocks in UGRA. They
are intended to support consistent practice, empower non-experts using basic
UGRA techniques, and standardize teaching and research.
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.
Background/importanceThere is heterogeneity among the outcomes used in regional anesthesia research.ObjectiveWe aimed to produce a core outcome set for regional anesthesia research.MethodsWe conducted a systematic review and Delphi study to develop this core outcome set. A systematic review of the literature from January 2015 to December 2019 was undertaken to generate a long list of potential outcomes to be included in the core outcome set. For each outcome found, the parameters such as the measurement scale, timing and definitions, were compiled. Regional anesthesia experts were then recruited to participate in a three-round electronic modified Delphi process with incremental thresholds to generate a core outcome set. Once the core outcomes were decided, a final Delphi survey and video conference vote was used to reach a consensus on the outcome parameters.ResultsTwo hundred and six papers were generated following the systematic review, producing a long list of 224 unique outcomes. Twenty-one international regional anesthesia experts participated in the study. Ten core outcomes were selected after three Delphi survey rounds with 13 outcome parameters reaching consensus after a final Delphi survey and video conference.ConclusionsWe present the first core outcome set for regional anesthesia derived by international expert consensus. These are proposed not to limit the outcomes examined in future studies, but rather to serve as a minimum core set. If adopted, this may increase the relevance of outcomes being studied, reduce selective reporting bias and increase the availability and suitability of data for meta-analysis in this area.
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