Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks
Authors: El-Boghdadly Kariem , Albrecht Eric , Wolmarans Morné , Mariano Edward R , Kopp Sandra , Perlas Anahi , Thottungal Athmaja , Gadsden Jeff , Tulgar Serkan , Adhikary Sanjib , Aguirre Jose , Agur Anne M R , Altıparmak Başak , Barrington Michael J , Bedforth Nigel , Blanco Rafael , Bloc Sébastien , Boretsky Karen , Bowness James , Breebaart Margaretha , Burckett-St Laurent David , Carvalho Brendan , Chelly Jacques E , Chin Ki Jinn , Chuan Alwin , Coppens Steve , Costache Ioana , Dam Mette , Desmet Matthias , Dhir Shalini , Egeler Christian , Elsharkawy Hesham , Bendtsen Thomas Fichtner , Fox Ben , Franco Carlo D , Gautier Philippe Emmanuel , Grant Stuart Alan , Grape Sina , Guheen Carrie , Harbell Monica W , Hebbard Peter , Hernandez Nadia , Hogg Rosemary M G , Holtz Margaret , Ihnatsenka Barys , Ilfeld Brian M , Ip Vivian H Y , Johnson Rebecca L , Kalagara Hari , Kessler Paul , Kwofie M Kwesi , Le-Wendling Linda , Lirk Philipp , Lobo Clara , Ludwin Danielle , Macfarlane Alan James Robert , Makris Alexandros , McCartney Colin , McDonnell John , McLeod Graeme A , Memtsoudis Stavros G , Merjavy Peter , Moran E M Louise , Nader Antoun , Neal Joseph M , Niazi Ahtsham U , Njathi-Ori Catherine , O'Donnell Brian D , Oldman Matt , Orebaugh Steven L , Parras Teresa , Pawa Amit , Peng Philip , Porter Steven , Pulos Bridget P , Sala-Blanch Xavier , Saporito Andrea , Sauter Axel R , Schwenk Eric S , Sebastian Maria Paz , Sidhu Navdeep , Sinha Sanjay Kumar , Soffin Ellen M , Stimpson James , Tang Raymond , Tsui Ban C H , Turbitt Lloyd , Uppal Vishal , van Geffen Geert J , Vermeylen Kris , Vlassakov Kamen , Volk Thomas , Xu Jeff L , Elkassabany Nabil M 
Published: November 2023

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.