RT Journal Article
SR Electronic
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
FD BMJ Publishing Group Ltd
SP 971
OP 985
DO 10.1136/rapm-2021-102750
VO 46
IS 11
A1 Stavros G Memtsoudis
A1 Crispiana Cozowicz
A1 Janis Bekeris
A1 Dace Bekere
A1 Jiabin Liu
A1 Ellen M Soffin
A1 Edward R Mariano
A1 Rebecca L Johnson
A1 George Go
A1 Mary J Hargett
A1 Bradley H Lee
A1 Pamela Wendel
A1 Mark Brouillette
A1 Sang Jo Kim
A1 Lila Baaklini
A1 Douglas S Wetmore
A1 Genewoo Hong
A1 Rie Goto
A1 Bridget Jivanelli
A1 Vassilis Athanassoglou
A1 Eriphili Argyra
A1 Michael John Barrington
A1 Alain Borgeat
A1 Jose De Andres
A1 Kariem El-Boghdadly
A1 Nabil M Elkassabany
A1 Philippe Gautier
A1 Peter Gerner
A1 Alejandro Gonzalez Della Valle
A1 Enrique Goytizolo
A1 Zhenggang Guo
A1 Rosemary Hogg
A1 Henrik Kehlet
A1 Paul Kessler
A1 Sandra Kopp
A1 Patricia Lavand'homme
A1 Alan Macfarlane
A1 Catherine MacLean
A1 Carlos Mantilla
A1 Dan McIsaac
A1 Alexander McLawhorn
A1 Joseph M Neal
A1 Michael Parks
A1 Javad Parvizi
A1 Philip Peng
A1 Lukas Pichler
A1 Jashvant Poeran
A1 Lazaros Poultsides
A1 Eric S Schwenk
A1 Brian D Sites
A1 Ottokar Stundner
A1 Eric C Sun
A1 Eugene Viscusi
A1 Effrossyni Gina Votta-Velis
A1 Christopher L Wu
A1 Jacques YaDeau
A1 Nigel E Sharrock
YR 2021
UL http://rapm.bmj.com/content/46/11/971.abstract
AB 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.