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

Toby Ashken, James Bowness (Lead / Corresponding author), 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. HoggDavid 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, Amit Pawa

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)762-772
Number of pages11
JournalRegional Anesthesia and Pain Medicine
Volume47
Issue number12
Early online date5 Sept 2022
DOIs
Publication statusPublished - 5 Sept 2022

Keywords

  • Humans
  • Ultrasonography, Interventional
  • Anesthesia, Conduction
  • Ultrasonography
  • Peripheral Nerves/diagnostic imaging
  • lower extremity (regional anesthesia)
  • ultrasonography
  • regional anesthesia
  • upper extremity (regional anesthesia)
  • pain management

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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