• Stavros G Memtsoudis, Crispiana Cozowicz, Janis Bekeris, Dace Bekere, Jiabin Liu, Ellen M Soffin, Edward R Mariano, Rebecca L Johnson, George Go, Mary J Hargett, Bradley H Lee, Pamela Wendel, Mark Brouillette, Sang Jo Kim, Lila Baaklini, Douglas S Wetmore, Genewoo Hong, Rie Goto, Bridget Jivanelli, Vassilis Athanassoglou, Eriphili Argyra, Michael John Barrington, Alain Borgeat, Jose De Andres, Kariem El-Boghdadly, Nabil M Elkassabany, Philippe Gautier, Peter Gerner, Gonzalez Della ValleAlejandroADepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York, USA., Enrique Goytizolo, Zhenggang Guo, Rosemary Hogg, Henrik Kehlet, Paul Kessler, Sandra Kopp, Patricia Lavand'homme, Alan Macfarlane, Catherine MacLean, Carlos Mantilla, Dan McIsaac, Alexander McLawhorn, Joseph M Neal, Michael Parks, Javad Parvizi, Philip Peng, Lukas Pichler, Jashvant Poeran, Lazaros Poultsides, Eric S Schwenk, Brian D Sites, Ottokar Stundner, Eric C Sun, Eugene Viscusi, Effrossyni Gina Votta-Velis, Christopher L Wu, Jacques YaDeau, and Nigel E Sharrock.
• Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA memtsoudiss@hss.edu.
• Reg Anesth Pain Med. 2021 Nov 1; 46 (11): 971-985.

BackgroundEvidence-based international expert consensus regarding the impact of peripheral nerve block (PNB) use in total hip/knee arthroplasty surgery.MethodsA 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.ResultsAnalysis 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).ConclusionsBased on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes.RecommendationPNB 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.© American Society of Regional Anesthesia & Pain Medicine 2021. No commercial re-use. See rights and permissions. Published by BMJ.

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