Table 3

Final list of recommendations

Patient information Level of agreement
Patient nameStrong
Patient date of birthStrong
Patient genderStrong
Patient medical record number/hospital numberStrong
Patient weightStrong
Patient heightStrong
Patient American Society of Anesthesiologists (ASA) physical status classificationStrong
Patient allergiesStrong
Procedure preparation
Block performed by _________ (name)Strong
Grade of block performer (e.g. consultant, fellow, resident, registrar)Weak
Name of supervisor (if applicable)Strong
Documentation of patient consent gained (as per local standards e.g. written, verbal)Strong
Documentation of individual risks of procedure discussed (as per local standards)Strong
Pre-anesthetic / block evaluationStrong
Coagulation consideredWeak
Pre-procedure diagnosis (post-operative pain management / surgical diagnosis)Strong
Timeout / World Health Organisation (WHO) checklistWeak
Stop moment performedStrong
Intravenous accessStrong
Regional anesthesia procedure nameStrong
Patient position during regional anesthesia procedureStrong
Monitors appliedStrong
Baseline vital signsStrong
Pre-medication (type and quantity of sedation)Strong
Level of sedation (no sedation / light sedation / deep sedation / general anesthesia)Strong
Procedure performance
Time and date of regional anesthesia procedureStrong
Aseptic agent usedStrong
Aseptic technique used as per local policyStrong
Skin infiltration with local anestheticStrong
Needle design: tip, manufacturer, length, gaugeStrong
Local anesthetic used for regional anesthesia technique (concentration and volume)Strong
Epinephrine dose if used (concentration)Strong
Adjunct used (e.g. bicarbonate, clonidine etc.)Strong
Specific for peripheral nerve block performance
Side of blockStrong
Technique of needle localization (ultrasound / nerve stimulator / landmark)Strong
No Evoked Motor Response (EMR) <_____mA (when applicable i.e. when nerve stimulator used)Strong
Minimum current and current duration (if nerve stimulator used)Strong
Absence of blood on aspirationStrong
Catheter depth at the skinStrong
Absence of pain / paresthesia during injectionStrong
ComplicationsStrong
Specific for neuraxial procedure performance
Technique (approach used eg, median/paramedian)Strong
Vertebral level of needle insertionStrong
Technique used: loss of resistance to saline/air for epidural insertionStrong
No of attemptsStrong
Epidural needle depth at loss of resistanceStrong
Catheter depth at the skinStrong
Note on aspiration and action takenStrong
Epidural test dose (if applicable)Strong
Absence of pain/paresthesia during injectionStrong
Dermatomal level of spinal of epidural block achieved (if assessed)Strong
ComplicationsStrong
Postprocedure
Patient vital signs after the procedureStrong
Postprocedure instructions (as per local standards)Strong