• Toby Ashken, James Bowness, MacfarlaneAlan James RobertAJR0000-0003-3858-6468Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK.University of Glasgow, Glasgow, UK., Lloyd Turbitt, Boyne Bellew, Nigel Bedforth, David Burckett-St Laurent, Alain Delbos, Kariem El-Boghdadly, Nabil M Elkassabany, Jenny Ferry, Ben Fox, James L H French, Calum Grant, Ashwani Gupta, Rajnish K Gupta, Yavuz Gürkan, Nat Haslam, Helen Higham, HoggRosemary M GRMGDepartment of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK., David F Johnston, Rachel Joyce Kearns, Clara Lobo, Sonya McKinlay, Edward R Mariano, Stavros Memtsoudis, Peter Merjavy, Madan Narayanan, J Alison Noble, David Phillips, Meg Rosenblatt, Amy Sadler, Maria Paz Sebastian, Eric S Schwenk, Alasdair Taylor, Athmaja Thottungal, Luis Fernando Valdés-Vilches, Thomas Volk, Simeon West, Morné Wolmarans, Jonathan Womack, and Amit Pawa.
• Department of Anaesthetics, University College London, London, UK.
• Reg Anesth Pain Med. 2022 Dec 1; 47 (12): 762-772.

AbstractRecent recommendations describe a set of core anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia (UGRA). This project aimed to generate consensus recommendations for core structures to identify during the performance of intermediate and advanced blocks. An initial longlist of structures was refined by an international panel of key opinion leaders in UGRA over a three-round Delphi process. All rounds were conducted virtually and anonymously. Blocks were considered twice in each round: for "orientation scanning" (the dynamic process of acquiring the final view) and for "block view" (which visualizes the block site and is maintained for needle insertion/injection). A "strong recommendation" was made if ≥75% of participants rated any structure as "definitely include" in any round. A "weak recommendation" was made if >50% of participants rated it as "definitely include" or "probably include" for all rounds, but the criterion for strong recommendation was never met. Structures which did not meet either criterion were excluded. Forty-one participants were invited and 40 accepted; 38 completed all three rounds. Participants considered the ultrasound scanning for 19 peripheral nerve blocks across all three rounds. Two hundred and seventy-four structures were reviewed for both orientation scanning and block view; a "strong recommendation" was made for 60 structures on orientation scanning and 44 on the block view. A "weak recommendation" was made for 107 and 62 structures, respectively. These recommendations are intended to help standardize teaching and research in UGRA and support widespread and consistent practice.© American Society of Regional Anesthesia & Pain Medicine 2022. No commercial re-use. See rights and permissions. Published by BMJ.

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