TY - JOUR T1 - 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-analysis of current literature JF - Regional Anesthesia & Pain Medicine JO - Reg Anesth Pain Med SP - 971 LP - 985 DO - 10.1136/rapm-2021-102750 VL - 46 IS - 11 AU - Stavros G Memtsoudis AU - Crispiana Cozowicz AU - Janis Bekeris AU - Dace Bekere AU - Jiabin Liu AU - Ellen M Soffin AU - Edward R Mariano AU - Rebecca L Johnson AU - George Go AU - Mary J Hargett AU - Bradley H Lee AU - Pamela Wendel AU - Mark Brouillette AU - Sang Jo Kim AU - Lila Baaklini AU - Douglas S Wetmore AU - Genewoo Hong AU - Rie Goto AU - Bridget Jivanelli AU - Vassilis Athanassoglou AU - Eriphili Argyra AU - Michael John Barrington AU - Alain Borgeat AU - Jose De Andres AU - Kariem El-Boghdadly AU - Nabil M Elkassabany AU - Philippe Gautier AU - Peter Gerner AU - Alejandro Gonzalez Della Valle AU - Enrique Goytizolo AU - Zhenggang Guo AU - Rosemary Hogg AU - Henrik Kehlet AU - Paul Kessler AU - Sandra Kopp AU - Patricia Lavand'homme AU - Alan Macfarlane AU - Catherine MacLean AU - Carlos Mantilla AU - Dan McIsaac AU - Alexander McLawhorn AU - Joseph M Neal AU - Michael Parks AU - Javad Parvizi AU - Philip Peng AU - Lukas Pichler AU - Jashvant Poeran AU - Lazaros Poultsides AU - Eric S Schwenk AU - Brian D Sites AU - Ottokar Stundner AU - Eric C Sun AU - Eugene Viscusi AU - Effrossyni Gina Votta-Velis AU - Christopher L Wu AU - Jacques YaDeau AU - Nigel E Sharrock Y1 - 2021/11/01 UR - http://rapm.bmj.com/content/46/11/971.abstract N2 - 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. ER -