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
AU - Memtsoudis, Stavros G.
AU - Cozowicz, Crispiana
AU - Bekeris, Janis
AU - Bekere, Dace
AU - Liu, Jiabin
AU - Soffin, Ellen M.
AU - Mariano, Edward R.
AU - Johnson, Rebecca L.
AU - Go, George
AU - Hargett, Mary J.
AU - Lee, Bradley H.
AU - Wendel, Pamela
AU - Brouillette, Mark
AU - Kim, Sang Jo
AU - Baaklini, Lila
AU - Wetmore, Douglas S.
AU - Hong, Genewoo
AU - Goto, Rie
AU - Jivanelli, Bridget
AU - Athanassoglou, Vassilis
AU - Argyra, Eriphili
AU - Barrington, Michael John
AU - Borgeat, Alain
AU - De Andres, Jose
AU - El-Boghdadly, Kariem
AU - Elkassabany, Nabil M.
AU - Gautier, Philippe
AU - Gerner, Peter
AU - Della Valle, Alejandro Gonzalez
AU - Goytizolo, Enrique
AU - Guo, Zhenggang
AU - Hogg, Rosemary
AU - Kehlet, Henrik
AU - Kessler, Paul
AU - Kopp, Sandra
AU - Lavand'homme, Patricia
AU - Macfarlane, Alan
AU - MacLean, Catherine
AU - Mantilla, Carlos
AU - McIsaac, Dan
AU - McLawhorn, Alexander
AU - Neal, Joseph M.
AU - Parks, Michael
AU - Parvizi, Javad
AU - Peng, Philip
AU - Pichler, Lukas
AU - Poeran, Jashvant
AU - Poultsides, Lazaros
AU - Schwenk, Eric S.
AU - Sites, Brian D.
AU - Stundner, Ottokar
AU - Sun, Eric C.
AU - Viscusi, Eugene
AU - Votta-Velis, Effrossyni Gina
AU - Wu, Christopher L.
AU - YaDeau, Jacques
AU - Sharrock, Nigel E.
PY - 2021/11/1
Y1 - 2021/11/1
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.
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.
UR - http://www.scopus.com/inward/record.url?scp=85120508248&partnerID=8YFLogxK
U2 - 10.1136/rapm-2021-102750
DO - 10.1136/rapm-2021-102750
M3 - Article
SN - 1098-7339
VL - 46
SP - 971
EP - 985
JO - REGIONAL ANESTHESIA AND PAIN MEDICINE
JF - REGIONAL ANESTHESIA AND PAIN MEDICINE
IS - 11
ER -