@article {Memtsoudis971, author = {Stavros G Memtsoudis and Crispiana Cozowicz and Janis Bekeris and Dace Bekere and Jiabin Liu and Ellen M Soffin and Edward R Mariano and Rebecca L Johnson and George Go and Mary J Hargett and Bradley H Lee and Pamela Wendel and Mark Brouillette and Sang Jo Kim and Lila Baaklini and Douglas S Wetmore and Genewoo Hong and Rie Goto and Bridget Jivanelli and Vassilis Athanassoglou and Eriphili Argyra and Michael John Barrington and Alain Borgeat and Jose De Andres and Kariem El-Boghdadly and Nabil M Elkassabany and Philippe Gautier and Peter Gerner and Alejandro Gonzalez Della Valle and Enrique Goytizolo and Zhenggang Guo and Rosemary Hogg and Henrik Kehlet and Paul Kessler and Sandra Kopp and Patricia Lavand{\textquoteright}homme and Alan Macfarlane and Catherine MacLean and Carlos Mantilla and Dan McIsaac and Alexander McLawhorn and Joseph M Neal and Michael Parks and Javad Parvizi and Philip Peng and Lukas Pichler and Jashvant Poeran and Lazaros Poultsides and Eric S Schwenk and Brian D Sites and Ottokar Stundner and Eric C Sun and Eugene Viscusi and Effrossyni Gina Votta-Velis and Christopher L Wu and Jacques YaDeau and Nigel E Sharrock}, title = {Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-anal{\textellipsis}}, volume = {46}, number = {11}, pages = {971--985}, year = {2021}, doi = {10.1136/rapm-2021-102750}, publisher = {BMJ Specialist Journals}, abstract = {Background Evidence-based international expert consensus regarding the impact of peripheral nerve block (PNB) use in total hip/knee arthroplasty surgery.Methods A systematic review and meta-analysis: randomized controlled and observational studies investigating the impact of PNB utilization on major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, thromboembolic, neurologic, infectious, and bleeding complications.Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, were queried from 1946 to August 4, 2020.The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess evidence quality and for the development of recommendations.Results Analysis of 122 studies revealed that PNB use (compared with no use) was associated with lower ORs for (OR with 95\% CIs) for numerous complications (total hip and knee arthroplasties (THA/TKA), respectively): cognitive dysfunction (OR 0.30, 95\% CI 0.17 to 0.53/OR 0.52, 95\% CI 0.34 to 0.80), respiratory failure (OR 0.36, 95\% CI 0.17 to 0.74/OR 0.37, 95\% CI 0.18 to 0.75), cardiac complications (OR 0.84, 95\% CI 0.76 to 0.93/OR 0.83, 95\% CI 0.79 to 0.86), surgical site infections (OR 0.55 95\% CI 0.47 to 0.64/OR 0.86 95\% CI 0.80 to 0.91), thromboembolism (OR 0.74, 95\% CI 0.58 to 0.96/OR 0.90, 95\% CI 0.84 to 0.96) and blood transfusion (OR 0.84, 95\% CI 0.83 to 0.86/OR 0.91, 95\% CI 0.90 to 0.92).Conclusions Based on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes.Recommendation: PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured. Evidence level: moderate; recommendation: strong.All data relevant to the study are included in the article or uploaded as supplementary information. Systematic review and meta-analysis.}, issn = {1098-7339}, URL = {https://rapm.bmj.com/content/46/11/971}, eprint = {https://rapm.bmj.com/content/46/11/971.full.pdf}, journal = {Regional Anesthesia \& Pain Medicine} }