Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks

Kariem El-Boghdadly; Eric Albrecht; Morné Wolmarans; Edward R. Mariano; Sandra Kopp; Anahi Perlas; Athmaja Thottungal; Jeff Gadsden; Serkan Tulgar; Sanjib Adhikary; Jose Aguirre; Anne M.R. Agur; Başak Altlparmak; Michael J. Barrington; Nigel 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; Ioana Costache; Mette Dam; Matthias Desmet; Shalini Dhir; Christian Egeler; Hesham Elsharkawy; Thomas Fichtner Bendtsen; Ben Fox; Carlo D. Franco; Philippe Emmanuel Gautier; Stuart Alan Grant; Sina Grape; Carrie Guheen; Monica W. Harbell; Peter Hebbard; Nadia Hernandez; Rosemary M.G. Hogg; Margaret Holtz; Barys Ihnatsenka; Brian M. Ilfeld; Vivian H.Y. Ip; Rebecca L. Johnson; Hari Kalagara; Paul Kessler; M. Kwesi Kwofie; Linda Le-Wendling; Philipp Lirk; Clara Lobo; Danielle Ludwin; Alan James Robert MacFarlane; Alexandros Makris; Colin McCartney; John McDonnell; Graeme A. McLeod; Stavros G. Memtsoudis; Peter Merjavy; E. M.Louise Moran; Antoun Nader; Joseph M. Neal; Ahtsham U. Niazi; Catherine Njathi-Ori; Brian D. O'Donnell; Matt Oldman; Steven L. Orebaugh; Teresa Parras; Amit Pawa; Philip Peng; Steven Porter; Bridget P. Pulos; Xavier Sala-Blanch; Andrea Saporito; Axel R. Sauter; Eric S. Schwenk; Maria Paz Sebastian; Navdeep Sidhu; Sanjay Kumar 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 M. Elkassabany

doi:10.1136/rapm-2023-104884

Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks

Kariem El-Boghdadly, Eric Albrecht, Morné Wolmarans, Edward R. Mariano, Sandra Kopp, Anahi Perlas, Athmaja Thottungal, Jeff Gadsden, Serkan Tulgar, Sanjib Adhikary, Jose Aguirre, Anne M.R. Agur, Başak Altlparmak, Michael J. Barrington, Nigel Bedforth, Rafael Blanco, Sébastien Bloc, Karen Boretsky, James Bowness, Margaretha BreebaartDavid Burckett-St Laurent, Brendan Carvalho, Jacques E. Chelly, Ki Jinn Chin, Alwin Chuan, Steve Coppens, Ioana Costache, Mette Dam, Matthias Desmet, Shalini Dhir, Christian Egeler, Hesham Elsharkawy, Thomas Fichtner Bendtsen, Ben Fox, Carlo D. Franco, Philippe Emmanuel Gautier, Stuart Alan Grant, Sina Grape, Carrie Guheen, Monica W. Harbell, Peter Hebbard, Nadia Hernandez, Rosemary M.G. Hogg, Margaret Holtz, Barys Ihnatsenka, Brian M. Ilfeld, Vivian H.Y. Ip, Rebecca L. Johnson, Hari Kalagara, Paul Kessler, M. Kwesi Kwofie, Linda Le-Wendling, Philipp Lirk, Clara Lobo, Danielle Ludwin, Alan James Robert MacFarlane, Alexandros Makris, Colin McCartney, John McDonnell, Graeme A. McLeod, Stavros G. Memtsoudis, Peter Merjavy, E. M.Louise Moran, Antoun Nader, Joseph M. Neal, Ahtsham U. Niazi, Catherine Njathi-Ori, Brian D. O'Donnell, Matt Oldman, Steven L. Orebaugh, Teresa Parras, Amit Pawa, Philip Peng, Steven Porter, Bridget P. Pulos, Xavier Sala-Blanch, Andrea Saporito, Axel R. Sauter, Eric S. Schwenk, Maria Paz Sebastian, Navdeep Sidhu, Sanjay Kumar 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 M. Elkassabany

Anesthesiology

Research output: Contribution to journal › Article › peer-review

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.

Original language	English (US)
Article number	104884
Journal	Regional Anesthesia and Pain Medicine
DOIs	https://doi.org/10.1136/rapm-2023-104884
State	Accepted/In press - 2023

Keywords

analgesia
Anesthesia, Local
Brachial Plexus
Lower Extremity
REGIONAL ANESTHESIA

ASJC Scopus subject areas

Anesthesiology and Pain Medicine

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10.1136/rapm-2023-104884

Cite this

El-Boghdadly, K., Albrecht, E., Wolmarans, M., Mariano, E. R., Kopp, S., Perlas, A., Thottungal, A., Gadsden, J., Tulgar, S., Adhikary, S., Aguirre, J., Agur, A. M. R., Altlparmak, B., Barrington, M. J., Bedforth, N., Blanco, R., Bloc, S., Boretsky, K., Bowness, J., ... Elkassabany, N. M. (Accepted/In press). Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks. Regional Anesthesia and Pain Medicine, Article 104884. https://doi.org/10.1136/rapm-2023-104884

El-Boghdadly, K, Albrecht, E, Wolmarans, M, Mariano, ER, Kopp, S, Perlas, A, Thottungal, A, Gadsden, J, Tulgar, S, Adhikary, S, Aguirre, J, Agur, AMR, Altlparmak, B, Barrington, MJ, Bedforth, N, Blanco, R, Bloc, S, Boretsky, K, Bowness, J, Breebaart, M, Burckett-St Laurent, D, Carvalho, B, Chelly, JE, Chin, KJ, Chuan, A, Coppens, S, Costache, I, Dam, M, Desmet, M, Dhir, S, Egeler, C, Elsharkawy, H, Bendtsen, TF, Fox, B, Franco, CD, Gautier, PE, Grant, SA, Grape, S, Guheen, C, Harbell, MW, Hebbard, P, Hernandez, N, Hogg, RMG, Holtz, M, Ihnatsenka, B, Ilfeld, BM, Ip, VHY, Johnson, RL, Kalagara, H, Kessler, P, Kwofie, MK, Le-Wendling, L, Lirk, P, Lobo, C, Ludwin, D, MacFarlane, AJR, Makris, A, McCartney, C, McDonnell, J, McLeod, GA, Memtsoudis, SG, Merjavy, P, Moran, EML, Nader, A, Neal, JM, Niazi, AU, Njathi-Ori, C, O'Donnell, BD, Oldman, M, Orebaugh, SL, Parras, T, Pawa, A, Peng, P, Porter, S, Pulos, BP, Sala-Blanch, X, Saporito, A, Sauter, AR, Schwenk, ES, Sebastian, MP, Sidhu, N, Sinha, SK, Soffin, EM, Stimpson, J, Tang, R, Tsui, BCH, Turbitt, L, Uppal, V, Van Geffen, GJ, Vermeylen, K, Vlassakov, K, Volk, T, Xu, JL & Elkassabany, NM 2023, 'Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks', Regional Anesthesia and Pain Medicine. https://doi.org/10.1136/rapm-2023-104884

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title = "Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks",

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.",

keywords = "analgesia, Anesthesia, Local, Brachial Plexus, Lower Extremity, REGIONAL ANESTHESIA",

author = "Kariem El-Boghdadly and Eric Albrecht and Morn{\'e} Wolmarans and Mariano, {Edward R.} and Sandra Kopp and Anahi Perlas and Athmaja Thottungal and Jeff Gadsden and Serkan Tulgar and Sanjib Adhikary and Jose Aguirre and Agur, {Anne M.R.} and Ba{\c s}ak Altlparmak and Barrington, {Michael J.} and Nigel Bedforth and Rafael Blanco and S{\'e}bastien Bloc and Karen Boretsky and James Bowness and Margaretha Breebaart and {Burckett-St Laurent}, David and Brendan Carvalho and Chelly, {Jacques E.} and Chin, {Ki Jinn} and Alwin Chuan and Steve Coppens and Ioana Costache and Mette Dam and Matthias Desmet and Shalini Dhir and Christian Egeler and Hesham Elsharkawy and Bendtsen, {Thomas Fichtner} and Ben Fox and Franco, {Carlo D.} and Gautier, {Philippe Emmanuel} and Grant, {Stuart Alan} and Sina Grape and Carrie Guheen and Harbell, {Monica W.} and Peter Hebbard and Nadia Hernandez and Hogg, {Rosemary M.G.} and Margaret Holtz and Barys Ihnatsenka and Ilfeld, {Brian M.} and Ip, {Vivian H.Y.} and Johnson, {Rebecca L.} and Hari Kalagara and Paul Kessler and Kwofie, {M. Kwesi} and Linda Le-Wendling and Philipp Lirk and Clara Lobo and Danielle Ludwin and MacFarlane, {Alan James Robert} and Alexandros Makris and Colin McCartney and John McDonnell and McLeod, {Graeme A.} and Memtsoudis, {Stavros G.} and Peter Merjavy and Moran, {E. M.Louise} and Antoun Nader and Neal, {Joseph M.} and Niazi, {Ahtsham U.} and Catherine Njathi-Ori and O'Donnell, {Brian D.} and Matt Oldman and Orebaugh, {Steven L.} and Teresa Parras and Amit Pawa and Philip Peng and Steven Porter and Pulos, {Bridget P.} and Xavier Sala-Blanch and Andrea Saporito and Sauter, {Axel R.} and Schwenk, {Eric S.} and Sebastian, {Maria Paz} and Navdeep Sidhu and Sinha, {Sanjay Kumar} and Soffin, {Ellen M.} and James Stimpson and Raymond Tang and Tsui, {Ban C.H.} and Lloyd Turbitt and Vishal Uppal and {Van Geffen}, {Geert J.} and Kris Vermeylen and Kamen Vlassakov and Thomas Volk and Xu, {Jeff L.} and Elkassabany, {Nabil M.}",

note = "Publisher Copyright: {\textcopyright} American Society of Regional Anesthesia & Pain Medicine 2023. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2023",

doi = "10.1136/rapm-2023-104884",

language = "English (US)",

journal = "Regional Anesthesia and Pain Medicine",

issn = "1098-7339",

publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Standardizing nomenclature in regional anesthesia

T2 - an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks

AU - El-Boghdadly, Kariem

AU - Albrecht, Eric

AU - Wolmarans, Morné

AU - Mariano, Edward R.

AU - Kopp, Sandra

AU - Perlas, Anahi

AU - Thottungal, Athmaja

AU - Gadsden, Jeff

AU - Tulgar, Serkan

AU - Adhikary, Sanjib

AU - Aguirre, Jose

AU - Agur, Anne M.R.

AU - Altlparmak, Başak

AU - Barrington, Michael J.

AU - Bedforth, Nigel

AU - Blanco, Rafael

AU - Bloc, Sébastien

AU - Boretsky, Karen

AU - Bowness, James

AU - Breebaart, Margaretha

AU - Burckett-St Laurent, David

AU - Carvalho, Brendan

AU - Chelly, Jacques E.

AU - Chin, Ki Jinn

AU - Chuan, Alwin

AU - Coppens, Steve

AU - Costache, Ioana

AU - Dam, Mette

AU - Desmet, Matthias

AU - Dhir, Shalini

AU - Egeler, Christian

AU - Elsharkawy, Hesham

AU - Bendtsen, Thomas Fichtner

AU - Fox, Ben

AU - Franco, Carlo D.

AU - Gautier, Philippe Emmanuel

AU - Grant, Stuart Alan

AU - Grape, Sina

AU - Guheen, Carrie

AU - Harbell, Monica W.

AU - Hebbard, Peter

AU - Hernandez, Nadia

AU - Hogg, Rosemary M.G.

AU - Holtz, Margaret

AU - Ihnatsenka, Barys

AU - Ilfeld, Brian M.

AU - Ip, Vivian H.Y.

AU - Johnson, Rebecca L.

AU - Kalagara, Hari

AU - Kessler, Paul

AU - Kwofie, M. Kwesi

AU - Le-Wendling, Linda

AU - Lirk, Philipp

AU - Lobo, Clara

AU - Ludwin, Danielle

AU - MacFarlane, Alan James Robert

AU - Makris, Alexandros

AU - McCartney, Colin

AU - McDonnell, John

AU - McLeod, Graeme A.

AU - Memtsoudis, Stavros G.

AU - Merjavy, Peter

AU - Moran, E. M.Louise

AU - Nader, Antoun

AU - Neal, Joseph M.

AU - Niazi, Ahtsham U.

AU - Njathi-Ori, Catherine

AU - O'Donnell, Brian D.

AU - Oldman, Matt

AU - Orebaugh, Steven L.

AU - Parras, Teresa

AU - Pawa, Amit

AU - Peng, Philip

AU - Porter, Steven

AU - Pulos, Bridget P.

AU - Sala-Blanch, Xavier

AU - Saporito, Andrea

AU - Sauter, Axel R.

AU - Schwenk, Eric S.

AU - Sebastian, Maria Paz

AU - Sidhu, Navdeep

AU - Sinha, Sanjay Kumar

AU - Soffin, Ellen M.

AU - Stimpson, James

AU - Tang, Raymond

AU - Tsui, Ban C.H.

AU - Turbitt, Lloyd

AU - Uppal, Vishal

AU - Van Geffen, Geert J.

AU - Vermeylen, Kris

AU - Vlassakov, Kamen

AU - Volk, Thomas

AU - Xu, Jeff L.

AU - Elkassabany, Nabil M.

PY - 2023

Y1 - 2023

N2 - 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.

AB - 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.

KW - analgesia

KW - Anesthesia, Local

KW - Brachial Plexus

KW - Lower Extremity

KW - REGIONAL ANESTHESIA

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UR - http://www.scopus.com/inward/citedby.url?scp=85178424253&partnerID=8YFLogxK

U2 - 10.1136/rapm-2023-104884

DO - 10.1136/rapm-2023-104884

M3 - Article

AN - SCOPUS:85178424253

SN - 1098-7339

JO - Regional Anesthesia and Pain Medicine

JF - Regional Anesthesia and Pain Medicine

M1 - 104884

ER -

Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks

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