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.
- regional anesthesia
- pain management
- lower extremity (regional anesthesia)
- upper extremity (regional anesthesia)
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Contributors Study concept, design, and conduct: TA, BB, JSB, AJRM, AP, and LT. Data collection: all authors. Manuscript preparation: TA and JSB. Manuscript editing: TA, BB, JSB, AJRM, AP, and LT. Manuscript review and approval: all authors. Guarantor: JSB.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests 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.
Provenance and peer review Not commissioned; externally peer reviewed.
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