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; 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. Hogg; David 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

doi:10.1136/rapm-2022-103738

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^*, 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

^*Corresponding author for this work

Centre for Human & Applied Physiological Sciences

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

9 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 language	English
Article number	rapm-2022-103738
Pages (from-to)	762-772
Number of pages	11
Journal	Regional anesthesia and pain medicine
Volume	47
Issue number	12
Early online date	5 Sept 2022
DOIs	https://doi.org/10.1136/rapm-2022-103738
Publication status	Published - 5 Sept 2022

Keywords

lower extremity (regional anesthesia)
pain management
regional anesthesia
ultrasonography
upper extremity (regional anesthesia)

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10.1136/rapm-2022-103738

Cite this

Ashken, T., Bowness, J., Macfarlane, A. J. R., Turbitt, L., Bellew, B., Bedforth, N., Burckett-St Laurent, D., Delbos, A., El-Boghdadly, K., Elkassabany, N. M., Ferry, J., Fox, B., French, J. L. H., Grant, C., Gupta, A., Gupta, R. K., Gürkan, Y., Haslam, N., Higham, H., ... Pawa, A. (2022). Recommendations for anatomical structures to identify on ultrasound for the performance of intermediate and advanced blocks in ultrasound-guided regional anesthesia. Regional anesthesia and pain medicine, 47(12), 762-772. Article rapm-2022-103738. https://doi.org/10.1136/rapm-2022-103738

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

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. ",

keywords = "lower extremity (regional anesthesia), pain management, regional anesthesia, ultrasonography, upper extremity (regional anesthesia)",

author = "Toby Ashken and James Bowness and Macfarlane, {Alan James Robert} and Lloyd Turbitt and Boyne Bellew and Nigel Bedforth and {Burckett-St Laurent}, David and Alain Delbos and Kariem El-Boghdadly and Elkassabany, {Nabil M.} and Jenny Ferry and Ben Fox and French, {James L.H.} and Calum Grant and Ashwani Gupta and Gupta, {Rajnish K.} and Yavuz G{\"u}rkan and Nat Haslam and Helen Higham and Hogg, {Rosemary M.G.} and Johnston, {David F.} and Kearns, {Rachel Joyce} and Clara Lobo and Sonya McKinlay and Mariano, {Edward R.} and Stavros Memtsoudis and Peter Merjavy and Madan Narayanan and Noble, {J. Alison} and David Phillips and Meg Rosenblatt and Amy Sadler and Sebastian, {Maria Paz} and Schwenk, {Eric S.} and Alasdair Taylor and Athmaja Thottungal and Vald{\'e}s-Vilches, {Luis Fernando} and Thomas Volk and Simeon West and Morn{\'e} Wolmarans and Jonathan Womack and Amit Pawa",

note = "Funding Information: AD, YG, CG, LFV-V, TV, and MW are members of the Executive Board of the ESRA. NME, RKG, and MR are members of the Board of Directors of the ASRA. ERM, SM, and ESS sit on ASRA Committees. TA, AG, NH, DFJ, RJK, AJRM, AP, MPS, AT, LT, SW, and JW are members of the Board of RA-UK. KEB is the Scientific Officer for the Difficult Airway Society. JSB, DBSL, AJRM, DP, and AT declare honoraria and/or research funding from Intelligent Ultrasound. JAN is a Senior Scientific Advisor for Intelligent Ultrasound. AP declares honoraria from GE Healthcare, Butterfly Net, Sintetica UK, and Pacira. Publisher Copyright: {\textcopyright}",

year = "2022",

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doi = "10.1136/rapm-2022-103738",

language = "English",

volume = "47",

pages = "762--772",

journal = "Regional anesthesia and pain medicine",

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Ashken, T, Bowness, J, Macfarlane, AJR, Turbitt, L, Bellew, B, Bedforth, N, Burckett-St Laurent, D, Delbos, A, El-Boghdadly, K, Elkassabany, NM, Ferry, J, Fox, B, French, JLH, Grant, C, Gupta, A, Gupta, RK, Gürkan, Y, Haslam, N, Higham, H, Hogg, RMG, Johnston, DF, Kearns, RJ, Lobo, C, McKinlay, S, Mariano, ER, Memtsoudis, S, Merjavy, P, Narayanan, M, Noble, JA, Phillips, D, Rosenblatt, M, Sadler, A, Sebastian, MP, Schwenk, ES, Taylor, A, Thottungal, A, Valdés-Vilches, LF, Volk, T, West, S, Wolmarans, M, Womack, J & Pawa, A 2022, 'Recommendations for anatomical structures to identify on ultrasound for the performance of intermediate and advanced blocks in ultrasound-guided regional anesthesia', Regional anesthesia and pain medicine, vol. 47, no. 12, rapm-2022-103738, pp. 762-772. https://doi.org/10.1136/rapm-2022-103738

Recommendations for anatomical structures to identify on ultrasound for the performance of intermediate and advanced blocks in ultrasound-guided regional anesthesia. / Ashken, Toby; Bowness, James; Macfarlane, Alan James Robert et al.
In: Regional anesthesia and pain medicine, Vol. 47, No. 12, rapm-2022-103738, 05.09.2022, p. 762-772.

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

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T1 - Recommendations for anatomical structures to identify on ultrasound for the performance of intermediate and advanced blocks in ultrasound-guided regional anesthesia

AU - Ashken, Toby

AU - Bowness, James

AU - Macfarlane, Alan James Robert

AU - Turbitt, Lloyd

AU - Bellew, Boyne

AU - Bedforth, Nigel

AU - Burckett-St Laurent, David

AU - Delbos, Alain

AU - El-Boghdadly, Kariem

AU - Elkassabany, Nabil M.

AU - Ferry, Jenny

AU - Fox, Ben

AU - French, James L.H.

AU - Grant, Calum

AU - Gupta, Ashwani

AU - Gupta, Rajnish K.

AU - Gürkan, Yavuz

AU - Haslam, Nat

AU - Higham, Helen

AU - Hogg, Rosemary M.G.

AU - Johnston, David F.

AU - Kearns, Rachel Joyce

AU - Lobo, Clara

AU - McKinlay, Sonya

AU - Mariano, Edward R.

AU - Memtsoudis, Stavros

AU - Merjavy, Peter

AU - Narayanan, Madan

AU - Noble, J. Alison

AU - Phillips, David

AU - Rosenblatt, Meg

AU - Sadler, Amy

AU - Sebastian, Maria Paz

AU - Schwenk, Eric S.

AU - Taylor, Alasdair

AU - Thottungal, Athmaja

AU - Valdés-Vilches, Luis Fernando

AU - Volk, Thomas

AU - West, Simeon

AU - Wolmarans, Morné

AU - Womack, Jonathan

AU - Pawa, Amit

N1 - Funding Information: AD, YG, CG, LFV-V, TV, and MW are members of the Executive Board of the ESRA. NME, RKG, and MR are members of the Board of Directors of the ASRA. ERM, SM, and ESS sit on ASRA Committees. TA, AG, NH, DFJ, RJK, AJRM, AP, MPS, AT, LT, SW, and JW are members of the Board of RA-UK. KEB is the Scientific Officer for the Difficult Airway Society. JSB, DBSL, AJRM, DP, and AT declare honoraria and/or research funding from Intelligent Ultrasound. JAN is a Senior Scientific Advisor for Intelligent Ultrasound. AP declares honoraria from GE Healthcare, Butterfly Net, Sintetica UK, and Pacira. Publisher Copyright: ©

PY - 2022/9/5

Y1 - 2022/9/5

N2 - 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.

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KW - lower extremity (regional anesthesia)

KW - pain management

KW - regional anesthesia

KW - ultrasonography

KW - upper extremity (regional anesthesia)

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Ashken T, Bowness J, Macfarlane AJR, Turbitt L, Bellew B, Bedforth N et al. Recommendations for anatomical structures to identify on ultrasound for the performance of intermediate and advanced blocks in ultrasound-guided regional anesthesia. Regional anesthesia and pain medicine. 2022 Sept 5;47(12):762-772. rapm-2022-103738. Epub 2022 Sept 5. doi: 10.1136/rapm-2022-103738

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

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