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Development of a Standardized Peripheral Nerve Block Procedure Note Form
  1. J. C. Gerancher, M.D.,
  2. Eugene R. Viscusi, M.D.,
  3. Gregory A. Liguori, M.D.,
  4. Colin J. McCartney, M.B.Ch.B., F.R.C.A.,
  5. Brian A. Williams, M.D., M.B.A.,
  6. Brian M. Ilfeld, M.D.,
  7. Stuart A. Grant, M.B., F.R.C.A.,
  8. James R. Hebl, M.D. and
  9. Admir Hadzic, M.D., Ph.D.
  1. From the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC
  2. Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA
  3. Department of Anesthesiology, Hospital for Special Surgery, New York, NY
  4. Department of Anesthesia, Toronto Western Hospital, Toronto, Canada
  5. Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA
  6. Florida Surgical Center, University of Florida, Gainesville, FL
  7. Department of Anesthesiology, Duke University Medical Center, Durham, NC
  8. Department of Anesthesiology, Mayo Clinic Rochester, Rochester, MN
  9. Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, New York, NY.
  1. Reprint requests: J. C. Gerancher, M.D., Department of Anesthesiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009. E-mail: jgeranch{at}


Objectives: Despite the tremendous growth of peripheral nerve blocks, no standard format exists to document their performance. Our objective was to create a peripheral nerve block form based on key elements of literature evidence and on our own group consensus.

Results: We describe the process and results of our multi-institutional effort to construct a standardized peripheral nerve block procedure form.

Conclusion: A form was developed to help meet the medical, legal, and billing requirements of documentation consistent with the performance of peripheral nerve block.

  • Regional anesthesia
  • Peripheral nerve block
  • Procedure note
  • Documentation
  • Medical record

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  • Presented in part at the Spring Meeting of the American Society of Regional Anesthesia and Pain Medicine, San Diego, CA, April 4-6, 2003, and Orlando, FL, March 11-14, 2004.