Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks
Kariem El‐Boghdadly, Éric Albrecht, Morné Wolmarans, Edward R. Mariano, Sandra L. Kopp, Anahi Perlas, Athmaja Thottungal, Jeff Gadsden, Serkan Tulgar, Sanjib Das Adhikary, José Aguirre, Anne Agur, Başak Altıparmak, Michael J. Barrington, N. Bedforth, Rafael Blanco, Sébastien Bloc, Karen Boretsky, James Bowness, Margaretha Breebaart, David Burckett-St Laurent, Brendan Carvalho, Jacques E. Chelly, Ki Jinn Chin, Alwin Chuan, Steve Coppens, I. Costache, Mette Dam, Matthias Desmet, Shalini Dhir, C. Egeler, Hesham Elsharkawy, Thomas Fichtner Bendtsen, Ben Fox, Carlo D. Franco, Philippe Gautier, Stuart A. Grant, Sina Grape, Carrie R. Guheen, Monica W. Harbell, Peter Hebbard, Nadia Hernandez, Rosemary Hogg, Margaret Holtz, Barys Ihnatsenka, Brian M. Ilfeld, Vivian Ip, Rebecca L. Johnson, Hari Kalagara, Paul Kessler, Kwesi Kwofie, Linda Le-Wendling, Philipp Lirk, Clara Lobo, Danielle Ludwin, Alan Macfarlane, Alexandros Μakris, Colin J. L. McCartney, John G. McDonnell, Graeme McLeod, Stavros G. Memtsoudis, Peter Merjavy, EML Moran, Antoun Nader, Joseph M. Neal, Ahtsham U. Niazi, Catherine Njathi-Ori, Brian D. OʼDonnell, Matt Oldman, Steven L. Orebaugh, Teresa Parras, Amit Pawa, Philip Peng, Steven B. Porter, Bridget P. Pulos, Xavier Sala‐Blanch, Andrea Saporito, Axel R. Sauter, Eric S. Schwenk, Maria Paz Sebastian, N. S. Sidhu, Sanjay K. Sinha, Ellen M. Soffin, James Stimpson, Raymond Tang, Ban C. H. Tsui, Lloyd Turbitt, Vishal Uppal, Geert J. van Geffen, Kris Vermeylen, Kamen Vlassakov, Thomas Volk, Jeff L. Xu, Nabil Elkassabany
Abstract
BACKGROUND: Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks. METHODS: We performed a three-round Delphi international consensus study to generate standardized names and anatomical descriptions of upper and lower limb regional anesthetic techniques. A long list of names and anatomical description of blocks of upper and lower extremities was produced by the members of the steering committee. Subsequently, two rounds of anonymized voting and commenting were followed by a third virtual round table to secure consensus for items that remained outstanding after the first and second rounds. As with previous methodology, strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. RESULTS: A total of 94, 91 and 65 collaborators participated in the first, second and third rounds, respectively. We achieved strong consensus for 38 names and 33 anatomical descriptions, and weak consensus for five anatomical descriptions. We agreed on a template for naming peripheral nerve blocks based on the name of the nerve and the anatomical location of the blockade and identified several areas for future research. CONCLUSIONS: We achieved consensus on nomenclature and anatomical descriptions of regional anesthetic techniques for upper and lower limb nerve blocks, and recommend using this framework in clinical and academic practice. This should improve research, teaching and learning of regional anesthesia to eventually improve patient care.