Comprehensive resources exist on how to plan a systematic review and meta-analysis. The objective of this article is to provide guidance to authors preparing their systematic review protocol in the fields of regional anesthesia and pain medicine. The focus is on systematic reviews of healthcare interventions, with or without an aggregate data meta-analysis. We describe and discuss elements of the systematic review methodology that review authors should prespecify, plan, and document in their protocol before commencing the review. Importantly, authors should explain their rationale for planning their systematic review and describe the PICO framework—participants (P), interventions (I),comparators (C), outcomes (O)—and related elements central to constructing their clinical question, framing an informative review title, determining the scope of the review, designing the search strategy, specifying the eligibility criteria, and identifying potential sources of heterogeneity. We highlight the importance of authors defining and prioritizing the primary outcome, defining eligibility criteria for selecting studies, and documenting sources of information and search strategies. The review protocol should also document methods used to evaluate risk of bias, quality (certainty) of the evidence, and heterogeneity of results. Furthermore, the authors should describe their plans for managing key data elements, the statistical construct used to estimate the intervention effect, methods of evidence synthesis and meta-analysis, and conditions when meta-analysis may not be possible, including the provision of practical solutions. Authors should provide enough detail in their protocol so that the readers could conduct the study themselves.
- Anesthesia, Local
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Contributors MJB conceived and led the development of this project (Parts I and II); drafted the original and subsequent versions of this manuscript including its format, structure, and important intellectual content; and prepared the original manuscript and subsequent revisions for resubmission. RSD contributed important intellectual content to this manuscript, drafted substantial content for versions of this manuscript, developed its format and structure, and approved the final version. EJM contributed important intellectual content to the manuscript, developed its format and structure, and approved the final version. SN contributed important intellectual content to the manuscript and approved the final version. GAK contributed important intellectual content to this manuscript, provided mentorship and content expertise, drafted substantial content for versions of this manuscript, developed its format and structure, and approved the final version. This manuscript was handled by: Thomas R. Vetter, MD, MPH, MFA.
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 MJB is a Regional Anesthesia and Acute Pain Medicine Executive Section Editor of Anesthesia & Analgesia. RSD None. EJM is Statistical Editor for Anesthesia & Analgesia. SN is a President of American Society of Regional Anesthesia and Pain Medicine. GAK is a Statistical Consultant for Regional Anesthesia and Pain Medicine.
Provenance and peer review Commissioned; internally peer reviewed.