Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks

Abstract

BackgroundThere is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques.MethodsWe conducted an international consensus study involving experts using a three-round Delphi method to produce a list of names and corresponding descriptions of anatomical targets. After long-list formulation by a Steering Committee, the first and second rounds involved anonymous electronic voting and commenting, with the third round involving a virtual round table discussion aiming to achieve consensus on items that had yet to achieve it. Novel names were presented where required for anatomical clarity and harmonization. Strong consensus was defined as ≥75% agreement and weak consensus as 50% to 74% agreement.ResultsSixty expert Collaborators participated in this study. After three rounds and clarification, harmonization, and introduction of novel nomenclature, strong consensus was achieved for the names of 16 block names and weak consensus for four names. For anatomical descriptions, strong consensus was achieved for 19 blocks and weak consensus was achieved for one approach. Several areas requiring further research were identified.ConclusionsHarmonization and standardization of nomenclature may improve education, research, and ultimately patient care. We present the first international consensus on nomenclature and anatomical descriptions of blocks of the abdominal wall, chest wall, and paraspinal blocks. We recommend using the consensus results in academic and clinical practice.

Use of ultrasound guided single shot costotransverse block (intertransverse process) in breast cancer surgery: a prospective, randomized, assessor blinded, controlled clinical trial

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“…Spinal analgesia with higher dose intrathecal opioids was consistently associated with improved analgesic outcomes, modest though they may be, as well as earlier recovery of bowel function, with no increase in LOS. The evidence for novel fascial plane block techniques such as TAP blocks and QLB (and their various approaches51) is either inconsistent or emerging, and the evidence supporting analgesic, functional or resource utilization outcomes with continuous wound infiltration catheters or intraperitoneal instillation of LA for either open or laparoscopic surgical approaches is unclear.…”

Standardizing nomenclature for fascial plane blocks: the destination not the journey

“…We thank Wou and Narayanan for their interest in our international consensus study aiming to standardize the nomenclature of fascial plane blocks 1 2. Opening the topic for discourse is an important next step in obtaining wider adoption and generalizability of our results.…”

“…Wou and Narayanan have identified an error in figure 2 in the original paper1 which incorrectly indicates that the transversus thoracic plane (TTP) block was harmonized with superficial rather than deep parasternal intercostal plane (PIP) block. We acknowledge this transcription error and thank them for pointing it out.…”