Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature

Stavros G. Memtsoudis; Crispiana Cozowicz; Janis Bekeris; Dace Bekere; Jiabin Liu; Ellen M. Soffin; Edward R. Mariano; Rebecca L. Johnson; George Go; Mary J. Hargett; Bradley H. Lee; Pamela Wendel; Mark Brouillette; Sang Jo Kim; Lila Baaklini; Douglas S. Wetmore; Genewoo Hong; Rie Goto; Bridget Jivanelli; Vassilis Athanassoglou; Eriphili Argyra; Michael John Barrington; Alain Borgeat; Jose De Andres; Kariem El-Boghdadly; Nabil M. Elkassabany; Philippe Gautier; Peter Gerner; Alejandro Gonzalez Della Valle; Enrique Goytizolo; Zhenggang Guo; Rosemary Hogg; Henrik Kehlet; Paul Kessler; Sandra Kopp; Patricia Lavand'homme; Alan Macfarlane; Catherine MacLean; Carlos Mantilla; Dan McIsaac; Alexander McLawhorn; Joseph M. Neal; Michael Parks; Javad Parvizi; Philip Peng; Lukas Pichler; Jashvant Poeran; Lazaros Poultsides; Eric S. Schwenk; Brian D. Sites; Ottokar Stundner; Eric C. Sun; Eugene Viscusi; Effrossyni Gina Votta-Velis; Christopher L. Wu; Jacques YaDeau; Nigel E. Sharrock

doi:10.1136/rapm-2021-102750

Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature

Stavros G. Memtsoudis, Crispiana Cozowicz, Janis Bekeris, Dace Bekere, Jiabin Liu, Ellen M. Soffin, Edward R. Mariano, Rebecca L. Johnson, George Go, Mary J. Hargett, Bradley H. Lee, Pamela Wendel, Mark Brouillette, Sang Jo Kim, Lila Baaklini, Douglas S. Wetmore, Genewoo Hong, Rie Goto, Bridget Jivanelli, Vassilis AthanassoglouEriphili Argyra, Michael John Barrington, Alain Borgeat, Jose De Andres, Kariem El-Boghdadly, Nabil M. Elkassabany, Philippe Gautier, Peter Gerner, Alejandro Gonzalez Della Valle, Enrique Goytizolo, Zhenggang Guo, Rosemary Hogg, Henrik Kehlet, Paul Kessler, Sandra Kopp, Patricia Lavand'homme, Alan Macfarlane, Catherine MacLean, Carlos Mantilla, Dan McIsaac, Alexander McLawhorn, Joseph M. Neal, Michael Parks, Javad Parvizi, Philip Peng, Lukas Pichler, Jashvant Poeran, Lazaros Poultsides, Eric S. Schwenk, Brian D. Sites, Ottokar Stundner, Eric C. Sun, Eugene Viscusi, Effrossyni Gina Votta-Velis, Christopher L. Wu, Jacques YaDeau, Nigel E. Sharrock

Centre for Human & Applied Physiological Sciences

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Abstract

BACKGROUND: Evidence-based international expert consensus regarding the impact of peripheral nerve block (PNB) use in total hip/knee arthroplasty surgery. METHODS: A systematic review and meta-analysis: randomized controlled and observational studies investigating the impact of PNB utilization on major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, thromboembolic, neurologic, infectious, and bleeding complications.Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, were queried from 1946 to August 4, 2020.The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess evidence quality and for the development of recommendations. RESULTS: Analysis of 122 studies revealed that PNB use (compared with no use) was associated with lower ORs for (OR with 95% CIs) for numerous complications (total hip and knee arthroplasties (THA/TKA), respectively): cognitive dysfunction (OR 0.30, 95% CI 0.17 to 0.53/OR 0.52, 95% CI 0.34 to 0.80), respiratory failure (OR 0.36, 95% CI 0.17 to 0.74/OR 0.37, 95% CI 0.18 to 0.75), cardiac complications (OR 0.84, 95% CI 0.76 to 0.93/OR 0.83, 95% CI 0.79 to 0.86), surgical site infections (OR 0.55 95% CI 0.47 to 0.64/OR 0.86 95% CI 0.80 to 0.91), thromboembolism (OR 0.74, 95% CI 0.58 to 0.96/OR 0.90, 95% CI 0.84 to 0.96) and blood transfusion (OR 0.84, 95% CI 0.83 to 0.86/OR 0.91, 95% CI 0.90 to 0.92). CONCLUSIONS: Based on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes. RECOMMENDATION: PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured. Evidence level: moderate; recommendation: strong.

Original language	English
Pages (from-to)	971-985
Number of pages	15
Journal	REGIONAL ANESTHESIA AND PAIN MEDICINE
Volume	46
Issue number	11
DOIs	https://doi.org/10.1136/rapm-2021-102750
Publication status	Published - 1 Nov 2021

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Memtsoudis, S. G., Cozowicz, C., Bekeris, J., Bekere, D., Liu, J., Soffin, E. M., Mariano, E. R., Johnson, R. L., Go, G., Hargett, M. J., Lee, B. H., Wendel, P., Brouillette, M., Kim, S. J., Baaklini, L., Wetmore, D. S., Hong, G., Goto, R., Jivanelli, B., ... Sharrock, N. E. (2021). Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. REGIONAL ANESTHESIA AND PAIN MEDICINE, 46(11), 971-985. https://doi.org/10.1136/rapm-2021-102750

Memtsoudis, Stavros G. ; Cozowicz, Crispiana ; Bekeris, Janis et al. / Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. In: REGIONAL ANESTHESIA AND PAIN MEDICINE. 2021 ; Vol. 46, No. 11. pp. 971-985.

@article{b6ef97a682424dc9b837361d5051a073,

title = "Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature",

abstract = "BACKGROUND: Evidence-based international expert consensus regarding the impact of peripheral nerve block (PNB) use in total hip/knee arthroplasty surgery. METHODS: A systematic review and meta-analysis: randomized controlled and observational studies investigating the impact of PNB utilization on major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, thromboembolic, neurologic, infectious, and bleeding complications.Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, were queried from 1946 to August 4, 2020.The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess evidence quality and for the development of recommendations. RESULTS: Analysis of 122 studies revealed that PNB use (compared with no use) was associated with lower ORs for (OR with 95% CIs) for numerous complications (total hip and knee arthroplasties (THA/TKA), respectively): cognitive dysfunction (OR 0.30, 95% CI 0.17 to 0.53/OR 0.52, 95% CI 0.34 to 0.80), respiratory failure (OR 0.36, 95% CI 0.17 to 0.74/OR 0.37, 95% CI 0.18 to 0.75), cardiac complications (OR 0.84, 95% CI 0.76 to 0.93/OR 0.83, 95% CI 0.79 to 0.86), surgical site infections (OR 0.55 95% CI 0.47 to 0.64/OR 0.86 95% CI 0.80 to 0.91), thromboembolism (OR 0.74, 95% CI 0.58 to 0.96/OR 0.90, 95% CI 0.84 to 0.96) and blood transfusion (OR 0.84, 95% CI 0.83 to 0.86/OR 0.91, 95% CI 0.90 to 0.92). CONCLUSIONS: Based on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes. RECOMMENDATION: PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured. Evidence level: moderate; recommendation: strong.",

author = "Memtsoudis, {Stavros G.} and Crispiana Cozowicz and Janis Bekeris and Dace Bekere and Jiabin Liu and Soffin, {Ellen M.} and Mariano, {Edward R.} and Johnson, {Rebecca L.} and George Go and Hargett, {Mary J.} and Lee, {Bradley H.} and Pamela Wendel and Mark Brouillette and Kim, {Sang Jo} and Lila Baaklini and Wetmore, {Douglas S.} and Genewoo Hong and Rie Goto and Bridget Jivanelli and Vassilis Athanassoglou and Eriphili Argyra and Barrington, {Michael John} and Alain Borgeat and {De Andres}, Jose and Kariem El-Boghdadly and Elkassabany, {Nabil M.} and Philippe Gautier and Peter Gerner and {Della Valle}, {Alejandro Gonzalez} and Enrique Goytizolo and Zhenggang Guo and Rosemary Hogg and Henrik Kehlet and Paul Kessler and Sandra Kopp and Patricia Lavand'homme and Alan Macfarlane and Catherine MacLean and Carlos Mantilla and Dan McIsaac and Alexander McLawhorn and Neal, {Joseph M.} and Michael Parks and Javad Parvizi and Philip Peng and Lukas Pichler and Jashvant Poeran and Lazaros Poultsides and Schwenk, {Eric S.} and Sites, {Brian D.} and Ottokar Stundner and Sun, {Eric C.} and Eugene Viscusi and Votta-Velis, {Effrossyni Gina} and Wu, {Christopher L.} and Jacques YaDeau and Sharrock, {Nigel E.}",

year = "2021",

month = nov,

day = "1",

doi = "10.1136/rapm-2021-102750",

language = "English",

volume = "46",

pages = "971--985",

journal = "REGIONAL ANESTHESIA AND PAIN MEDICINE",

issn = "1098-7339",

publisher = "Lippincott Williams and Wilkins",

number = "11",

}

Memtsoudis, SG, Cozowicz, C, Bekeris, J, Bekere, D, Liu, J, Soffin, EM, Mariano, ER, Johnson, RL, Go, G, Hargett, MJ, Lee, BH, Wendel, P, Brouillette, M, Kim, SJ, Baaklini, L, Wetmore, DS, Hong, G, Goto, R, Jivanelli, B, Athanassoglou, V, Argyra, E, Barrington, MJ, Borgeat, A, De Andres, J, El-Boghdadly, K, Elkassabany, NM, Gautier, P, Gerner, P, Della Valle, AG, Goytizolo, E, Guo, Z, Hogg, R, Kehlet, H, Kessler, P, Kopp, S, Lavand'homme, P, Macfarlane, A, MacLean, C, Mantilla, C, McIsaac, D, McLawhorn, A, Neal, JM, Parks, M, Parvizi, J, Peng, P, Pichler, L, Poeran, J, Poultsides, L, Schwenk, ES, Sites, BD, Stundner, O, Sun, EC, Viscusi, E, Votta-Velis, EG, Wu, CL, YaDeau, J & Sharrock, NE 2021, 'Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature', REGIONAL ANESTHESIA AND PAIN MEDICINE, vol. 46, no. 11, pp. 971-985. https://doi.org/10.1136/rapm-2021-102750

Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. / Memtsoudis, Stavros G.; Cozowicz, Crispiana; Bekeris, Janis et al.
In: REGIONAL ANESTHESIA AND PAIN MEDICINE, Vol. 46, No. 11, 01.11.2021, p. 971-985.

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

TY - JOUR

T1 - Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature

AU - Memtsoudis, Stavros G.

AU - Cozowicz, Crispiana

AU - Bekeris, Janis

AU - Bekere, Dace

AU - Liu, Jiabin

AU - Soffin, Ellen M.

AU - Mariano, Edward R.

AU - Johnson, Rebecca L.

AU - Go, George

AU - Hargett, Mary J.

AU - Lee, Bradley H.

AU - Wendel, Pamela

AU - Brouillette, Mark

AU - Kim, Sang Jo

AU - Baaklini, Lila

AU - Wetmore, Douglas S.

AU - Hong, Genewoo

AU - Goto, Rie

AU - Jivanelli, Bridget

AU - Athanassoglou, Vassilis

AU - Argyra, Eriphili

AU - Barrington, Michael John

AU - Borgeat, Alain

AU - De Andres, Jose

AU - El-Boghdadly, Kariem

AU - Elkassabany, Nabil M.

AU - Gautier, Philippe

AU - Gerner, Peter

AU - Della Valle, Alejandro Gonzalez

AU - Goytizolo, Enrique

AU - Guo, Zhenggang

AU - Hogg, Rosemary

AU - Kehlet, Henrik

AU - Kessler, Paul

AU - Kopp, Sandra

AU - Lavand'homme, Patricia

AU - Macfarlane, Alan

AU - MacLean, Catherine

AU - Mantilla, Carlos

AU - McIsaac, Dan

AU - McLawhorn, Alexander

AU - Neal, Joseph M.

AU - Parks, Michael

AU - Parvizi, Javad

AU - Peng, Philip

AU - Pichler, Lukas

AU - Poeran, Jashvant

AU - Poultsides, Lazaros

AU - Schwenk, Eric S.

AU - Sites, Brian D.

AU - Stundner, Ottokar

AU - Sun, Eric C.

AU - Viscusi, Eugene

AU - Votta-Velis, Effrossyni Gina

AU - Wu, Christopher L.

AU - YaDeau, Jacques

AU - Sharrock, Nigel E.

PY - 2021/11/1

Y1 - 2021/11/1

N2 - BACKGROUND: Evidence-based international expert consensus regarding the impact of peripheral nerve block (PNB) use in total hip/knee arthroplasty surgery. METHODS: A systematic review and meta-analysis: randomized controlled and observational studies investigating the impact of PNB utilization on major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, thromboembolic, neurologic, infectious, and bleeding complications.Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, were queried from 1946 to August 4, 2020.The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess evidence quality and for the development of recommendations. RESULTS: Analysis of 122 studies revealed that PNB use (compared with no use) was associated with lower ORs for (OR with 95% CIs) for numerous complications (total hip and knee arthroplasties (THA/TKA), respectively): cognitive dysfunction (OR 0.30, 95% CI 0.17 to 0.53/OR 0.52, 95% CI 0.34 to 0.80), respiratory failure (OR 0.36, 95% CI 0.17 to 0.74/OR 0.37, 95% CI 0.18 to 0.75), cardiac complications (OR 0.84, 95% CI 0.76 to 0.93/OR 0.83, 95% CI 0.79 to 0.86), surgical site infections (OR 0.55 95% CI 0.47 to 0.64/OR 0.86 95% CI 0.80 to 0.91), thromboembolism (OR 0.74, 95% CI 0.58 to 0.96/OR 0.90, 95% CI 0.84 to 0.96) and blood transfusion (OR 0.84, 95% CI 0.83 to 0.86/OR 0.91, 95% CI 0.90 to 0.92). CONCLUSIONS: Based on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes. RECOMMENDATION: PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured. Evidence level: moderate; recommendation: strong.

AB - BACKGROUND: Evidence-based international expert consensus regarding the impact of peripheral nerve block (PNB) use in total hip/knee arthroplasty surgery. METHODS: A systematic review and meta-analysis: randomized controlled and observational studies investigating the impact of PNB utilization on major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, thromboembolic, neurologic, infectious, and bleeding complications.Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, were queried from 1946 to August 4, 2020.The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess evidence quality and for the development of recommendations. RESULTS: Analysis of 122 studies revealed that PNB use (compared with no use) was associated with lower ORs for (OR with 95% CIs) for numerous complications (total hip and knee arthroplasties (THA/TKA), respectively): cognitive dysfunction (OR 0.30, 95% CI 0.17 to 0.53/OR 0.52, 95% CI 0.34 to 0.80), respiratory failure (OR 0.36, 95% CI 0.17 to 0.74/OR 0.37, 95% CI 0.18 to 0.75), cardiac complications (OR 0.84, 95% CI 0.76 to 0.93/OR 0.83, 95% CI 0.79 to 0.86), surgical site infections (OR 0.55 95% CI 0.47 to 0.64/OR 0.86 95% CI 0.80 to 0.91), thromboembolism (OR 0.74, 95% CI 0.58 to 0.96/OR 0.90, 95% CI 0.84 to 0.96) and blood transfusion (OR 0.84, 95% CI 0.83 to 0.86/OR 0.91, 95% CI 0.90 to 0.92). CONCLUSIONS: Based on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes. RECOMMENDATION: PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured. Evidence level: moderate; recommendation: strong.

UR - http://www.scopus.com/inward/record.url?scp=85120508248&partnerID=8YFLogxK

U2 - 10.1136/rapm-2021-102750

DO - 10.1136/rapm-2021-102750

M3 - Article

SN - 1098-7339

VL - 46

SP - 971

EP - 985

JO - REGIONAL ANESTHESIA AND PAIN MEDICINE

JF - REGIONAL ANESTHESIA AND PAIN MEDICINE

IS - 11

ER -

Memtsoudis SG, Cozowicz C, Bekeris J, Bekere D, Liu J, Soffin EM et al. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. REGIONAL ANESTHESIA AND PAIN MEDICINE. 2021 Nov 1;46(11):971-985. doi: 10.1136/rapm-2021-102750

Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature

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