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Original research
Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks
  1. Kariem El-Boghdadly1,
  2. Eric Albrecht2,3,
  3. Morné Wolmarans4,
  4. Edward R Mariano5,6,
  5. Sandra Kopp7,
  6. Anahi Perlas8,
  7. Athmaja Thottungal8,
  8. Jeff Gadsden8,
  9. Serkan Tulgar9,
  10. Sanjib Adhikary10,
  11. Jose Aguirre11,
  12. Anne M R Agur12,
  13. Başak Altıparmak13,
  14. Michael J Barrington14,
  15. Nigel Bedforth15,
  16. Rafael Blanco16,
  17. Sébastien Bloc17,
  18. Karen Boretsky18,
  19. James Bowness19,20,21,
  20. Margaretha Breebaart22,23,
  21. David Burckett-St Laurent24,
  22. Brendan Carvalho25,
  23. Jacques E Chelly26,
  24. Ki Jinn Chin8,
  25. Alwin Chuan27,28,
  26. Steve Coppens29,
  27. Ioana Costache30,
  28. Mette Dam31,
  29. Matthias Desmet32,
  30. Shalini Dhir33,
  31. Christian Egeler34,
  32. Hesham Elsharkawy35,
  33. Thomas Fichtner Bendtsen36,
  34. Ben Fox37,
  35. Carlo D Franco38,
  36. Philippe Emmanuel Gautier39,
  37. Stuart Alan Grant40,
  38. Sina Grape41,
  39. Carrie Guheen42,
  40. Monica W Harbell43,
  41. Peter Hebbard44,
  42. Nadia Hernandez45,
  43. Rosemary M G Hogg46,
  44. Margaret Holtz47,
  45. Barys Ihnatsenka48,
  46. Brian M Ilfeld49,50,
  47. Vivian H Y Ip51,
  48. Rebecca L Johnson52,
  49. Hari Kalagara53,
  50. Paul Kessler54,
  51. M Kwesi Kwofie55,
  52. Linda Le-Wendling56,
  53. Philipp Lirk57,58,
  54. Clara Lobo59,
  55. Danielle Ludwin60,
  56. Alan James Robert Macfarlane61,62,
  57. Alexandros Makris63,
  58. Colin McCartney64,
  59. John McDonnell65,
  60. Graeme A McLeod66,67,
  61. Stavros G Memtsoudis68,
  62. Peter Merjavy69,
  63. E M Louise Moran70,
  64. Antoun Nader71,
  65. Joseph M Neal72,
  66. Ahtsham U Niazi73,
  67. Catherine Njathi-Ori52,
  68. Brian D O'Donnell74,
  69. Matt Oldman75,
  70. Steven L Orebaugh76,
  71. Teresa Parras77,
  72. Amit Pawa78,79,
  73. Philip Peng80,
  74. Steven Porter81,
  75. Bridget P Pulos52,
  76. Xavier Sala-Blanch82,83,
  77. Andrea Saporito84,
  78. Axel R Sauter85,
  79. Eric S Schwenk86,
  80. Maria Paz Sebastian87,
  81. Navdeep Sidhu88,
  82. Sanjay Kumar Sinha89,
  83. Ellen M Soffin90,
  84. James Stimpson91,
  85. Raymond Tang92,
  86. Ban C H Tsui93,
  87. Lloyd Turbitt94,
  88. Vishal Uppal95,
  89. Geert J van Geffen96,
  90. Kris Vermeylen97,
  91. Kamen Vlassakov98,
  92. Thomas Volk99,
  93. Jeff L Xu100,101 and
  94. Nabil M Elkassabany102
  1. 1Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
  2. 2Department of Anaesthesia, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  3. 3University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
  4. 4Anaesthesiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
  5. 5Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
  6. 6Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
  7. 7Anesthesiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
  8. 8Duke University Medical Center, Durham, North Carolina, USA
  9. 9Anesthesiology, Samsun University, Canik, Turkey
  10. 10Anesthesiology and Perioperative Medicine, Penn State, University Park, Pennsylvania, USA
  11. 11Ambulatory Center Europaallee, City Hospital Zurich, Zurich, Switzerland
  12. 12Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  13. 13Anesthesiology, Mugla Sitki Kocman Universitesi, Mugla, Turkey
  14. 14Anesthesia, Oregon Health & Science University, Portland, Oregon, USA
  15. 15Department of Anaesthesia and Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
  16. 16Anaesthesia and Intensive Care, Corniche Hospital, Abu Dhabi, UAE
  17. 17Anesthesiology Department, Clinique Drouot Sport, Paris, France
  18. 18Anesthesiology, Critical Care and Pain Medicine, Boston's Children's Hospital, Boston, Massachusetts, USA
  19. 19Department of Anesthesia, Oxford University, Oxford, UK
  20. 20Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
  21. 21Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
  22. 22Department of Health Sciences, University of Antwerp, Antwerpen, Belgium
  23. 23Anesthesia, University Hospital Antwerp, Antwerp, Belgium
  24. 24Anaesthesia, Royal Cornwall Hospitals NHS Trust, Truro, UK
  25. 25Stanford University, Stanford, California, USA
  26. 26Anesthesiology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
  27. 27Liverpool Hospital, Liverpool, New South Wales, Australia
  28. 28University of New South Wales, South West Sydney, New South Wales, Australia
  29. 29Anesthesiology, KU Leuven University Hospitals, Leuven, Belgium
  30. 30Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
  31. 31Department of Anesthesia and Intensive Care, University Hospital Hvidore, Copenhagen, Denmark
  32. 32Anesthesia, AZ Groeninge, Kortrijk, Belgium
  33. 33Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
  34. 34Swansea Bay University Health Board, Port Talbot, UK
  35. 35Anesthesiology, MetroHealth Medical Center, Cleveland, Ohio, USA
  36. 36Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
  37. 37Anaesthesia, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
  38. 38Anesthesiology, John H. Stroger Jr. Hospital of Cook Country, Rush University Medical Center, Chicago, Illinois, USA
  39. 39Clinique Ste Anne- St Remi, Brussels, Belgium
  40. 40Anesthesiology, The University of North Carolina, Chapel Hill, North Carolina, USA
  41. 41Anesthesia, Hôpital du Valais, Sion, Switzerland
  42. 42Anesthesia, Hospital for Special Surgery, New York, New York, USA
  43. 43Anesthesia, Mayo Clinic, Phoenix, Arizona, USA
  44. 44Department of Anesthesia Northeast Health, Ultrasound Education Group, The University of Melbourne Rural Health Academic Centre, Wangaratta, Victoria, Australia
  45. 45Anesthesiology, University of Texas McGovern Medical School, Houston, Texas, USA
  46. 46Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
  47. 47Anesthesia, WellStar Health System, Marietta, Georgia, USA
  48. 48Anesthesiology, University of Florida, Gainesville, Florida, USA
  49. 49Anesthesia, University of California, La Jolla, California, USA
  50. 50Anesthesia, University of California San Diego, La Jolla, California, USA
  51. 51Department of Anesthesia and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
  52. 52Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
  53. 53Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA
  54. 54Anesthesiology, Intensive Care and Pain Medicine, University Hospital Frankfurt, Frankfurt, Germany
  55. 55Department of Anesthesia, Perioperative Medicine and Pain Managaement, Dalhousie University, Halifax, Nova Scotia, Canada
  56. 56Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
  57. 57Dept. of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  58. 58Harvard Medical School, Boston, Massachusetts, USA
  59. 59Cleveland Clinic, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
  60. 60Columbia University Medical Center, New York, New York, USA
  61. 61Glasgow Royal Infirmary, Glasgow, UK
  62. 62University of Glasgow, Glasgow, UK
  63. 63Asklepieion Hospital of Voula, Athens, Greece
  64. 64Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  65. 65University Hospital Galway, Galway, Ireland
  66. 66Department of Anaesthesia, NHS Tayside, Dundee, UK
  67. 67Instittute of Academic Anaesthesia, University of Dundee, Dundee, UK
  68. 68Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
  69. 69Anaesthetic, Craigavon Area Hospital, Portadown, UK
  70. 70Anaesthesia and Critical Care, Letterkenny University Hospital, Letterkenny, Ireland
  71. 71Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  72. 72Anesthesiology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
  73. 73Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  74. 74Cork University Hospital, Cork, Ireland
  75. 75University Hospitals Plymouth NHS Trust, Plymouth, UK
  76. 76Anesthesiology, University of Pittsburgh Medical Center-Southside, Pittsburgh, Pennsylvania, USA
  77. 77Anesthesiology, Critical Care, and Pain Medicine, Hospital Quironsalud, Malaga, Spain
  78. 78Department of Anaesthesia, St Thomas' Hospital, London, UK
  79. 79Faculty of Life Sciences and Medicine, King's college London, London, UK
  80. 80Anesthesia, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
  81. 81Mayo Clinic Florida, Jacksonville, Florida, USA
  82. 82Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain
  83. 83Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
  84. 84Anesthesia, Ospedale Regionale di Bellinzona e Valli Bellinzona, Bellinzona, Switzerland
  85. 85Department of Anaesthesiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
  86. 86Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  87. 87Anaesthetics, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
  88. 88Anesthesia and Perioperative Medicine, North shore Hospital, Auckland, New Zealand
  89. 89Anesthesiology, Woodland Anesthesiology Associates, Hartford, Connecticut, USA
  90. 90Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
  91. 91Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
  92. 92Anesthesia, Vancouver General Hospital, Vancouver, British Columbia, Canada
  93. 93Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
  94. 94Department of Anesthesia, Belfast Health and Social Care trust, Belfast, UK
  95. 95Anesthesia, Dalhousie University - Faculty of Health Professions, Halifax, Nova Scotia, Canada
  96. 96Anesthesiology, Radboud University, Nijmegen, The Netherlands
  97. 97Anesthesia and Intensive Care, Algemeen Ziekenhuis Turnhout Campus Sint Elisabeth, Turnhout, Belgium
  98. 98Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
  99. 99Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
  100. 100Anesthesiology, New York Medical College, Valhalla, New York, USA
  101. 101Anesthesiology, Westchester Medical Center, Valhalla, New York, USA
  102. 102Anesthesiology & Critical Care, University of Virginia, Charlottesville, Virginia, USA
  1. Correspondence to Dr Nabil M Elkassabany, Anesthesiology & Critical Care, University of Virginia, Charlottesville, VA, 22903, USA; nelkassabany{at}gmail.com

Abstract

Background Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks.

Methods We performed a three-round Delphi international consensus study to generate standardized names and anatomical descriptions of upper and lower limb regional anesthetic techniques. A long list of names and anatomical description of blocks of upper and lower extremities was produced by the members of the steering committee. Subsequently, two rounds of anonymized voting and commenting were followed by a third virtual round table to secure consensus for items that remained outstanding after the first and second rounds. As with previous methodology, strong consensus was defined as ≥75% agreement and weak consensus as 50%–74% agreement.

Results A total of 94, 91 and 65 collaborators participated in the first, second and third rounds, respectively. We achieved strong consensus for 38 names and 33 anatomical descriptions, and weak consensus for five anatomical descriptions. We agreed on a template for naming peripheral nerve blocks based on the name of the nerve and the anatomical location of the blockade and identified several areas for future research.

Conclusions We achieved consensus on nomenclature and anatomical descriptions of regional anesthetic techniques for upper and lower limb nerve blocks, and recommend using this framework in clinical and academic practice. This should improve research, teaching and learning of regional anesthesia to eventually improve patient care.

  • analgesia
  • Anesthesia, Local
  • REGIONAL ANESTHESIA
  • Brachial Plexus
  • Lower Extremity

Data availability statement

Data are available in a public, open access repository. Not applicable.

https://doi.org/10.1136/rapm-2023-104884

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    Data availability statement

    Data are available in a public, open access repository. Not applicable.

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    Footnotes

    • Twitter @elboghdadly, @DrEAlbrecht, @EMARIANOMD, @PerlasAnahi, @SerkanTulgarMD, @sanjibadhikary, @baakaltparmak1, @nigeb444, @bowness_james, @CarvalB, @kijinnchin, @AlwinChuan, @Steve_Coppens, @kaohesham, @MonicaHarbellMD, @rosie_hogg, @HoltzMaggie, @rljohnsonmd, @MKwesiKwofie, @claralexlobo, @ajrmacfarlane, @colinjmccartney, @gamcleod2, @sgmemtsoudis, @PeterMerjavy, @LouiseMoran75, @AhtshamNiazi, @amit_pawa, @DrPhilipPeng, @BridgetPulos, @ESchwenkMD, @mariapsebastian, @ESoffin, @DrRayTang, @LloydTurbitt, @Ropivacaine, @KVermeylen, @nelkassabany

    • Contributors Study conception and design: KE-B, EA, NME, SK, ERM and MW. Study conduct: KE-B, EA, JG, NME, SK, ERM, AT, AS and APerlas. Data analysis: KE-B, NME and AS. Manuscript preparation: KE-B, NME. Manuscript revision: KE-B, EA, JG, NME, SK, ERM, AT, AS and APawa. Manuscript approval: all authors. Guarantors: NE, KE, EA, AP, ERM, SK, AT, JG.

    • 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 EA: grants from Swiss Academy for Anesthesia Research, Bbraun, Swiss National Science Foundation. Honoraria from Bbraun and Sintetica. JG: consulting fees from Pacira Biosciences and Pajunk Medical. AP: honoraria from FuijiFilm Sonosite. MW: advisory Board for Sintetica, Honoraria from Wisonic and Medovate. SA: Advisory Panel for DATAR innovations. JA: moderator of the Working Group Regional Anaesthesia Switzerland, Honoraria from Medtronic and Sintetica. AMRA: honoraria form AllerganSébastien Bloc—Consulting fees from BBraun—GE Medical Systems—Pajunk—Pfizer SAS. JB: Consulting fees from Intelligent Ultrasound. BC: jonoraria from Bbraun and Rivanna, Consulting from Stryker and Flat Medical, Research funding from Pacira, Share Options from Flat Medical. AC: speaking honoraria from GE Healthcare, royalties from textbook Oxford University Press. SC: consulting fees from MSD, Bbraun Medical, Wisonic, research grants from BARA (Belgian association of Regional anesthesia), ESRA and BeSARP (Belgian anesthesia society) HE-Consulting/Advisory Board Neuronoff, SPR, GateScience, NeuronoffBenjamin Fox—Speaking fees from Medovate and Sintetica. SG: consulting and speaking fees from MSD Switzerland. PH: royalties from Bestek Products. NH: Honoraria from Butterfly Network. RMGH- Honoraria from GE Healthcare. MH: consulting fees from Pacira Biosciences, Honoraria from Parcira Biosciences and Pajunk Medical. BMI: research funding to institution from SPR Therapeutics, Infutronix, Epimed International. AM: Consultant fees from Intelligent Ultrasound. CM: consultant fees from Masimo Corporation. SGM: Owner SGM Consulting, Partner Parvizi Surgical Innovations, Patent for Multicatheter infusion system. AN: Research support from SPR Therapeutics. SLO: Royalties from book Wolters-Kluwer. APawa: Honoraria from GE Healthcare, Consulting fees from Pacira Biosciences. PP: equipment support from Sonosiite Fujifilm Canada. MPS: Medovate speaking but no honoraria paid. SKS- Cofounder of Gate Science (developing a catheter for performing nerve blocks) JS: consulting fees from Sintetica. RT: Consulting fees from Clarius Mobile Health. VU: Associate Editor of the Canadian Journal of Anesthesia and Regional Anesthesia & Pain Medicine journals. TV: honoraria from CSL Behring, Pajunk.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.