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
Stavros G Memtsoudis
1, 2, 3
,
Crispiana Cozowicz
4, 5
,
Janis Bekeris
4, 5
,
Dace Bekere
4, 5
,
Jiabin Liu
1, 2, 3
,
Ellen M. Soffin
1, 2, 3
,
Edward R. Mariano
6, 7, 8, 9
,
Rebecca L. Johnson
10, 11
,
GEORGE GO
1, 2
,
MARY JEAN HARGETT
1, 2
,
Bradley H. Lee
1, 2, 3
,
Pamela Wendel
1, 2, 3
,
Mark Brouillette
1, 2, 3
,
Sang Jo Kim
1, 2, 3
,
Lila Baaklini
1, 2, 3
,
Douglas S. Wetmore
1, 2, 3
,
Genewoo Hong
1, 2, 3
,
Rie Goto
1, 2
,
Bridget Jivanelli
1, 2
,
Vassilis Athanassoglou
12, 13
,
Eriphili Argyra
14, 15
,
Michael J. Barrington
10, 16
,
Alain Borgeat
17, 18
,
Jose De Andres
19, 20, 21, 22
,
Kariem El-Boghdadly
23, 24
,
Nabil Elkassabany
25, 26
,
Philippe Gautier
27, 28
,
Peter Gerner
4, 5
,
Alejandro Gonzalez Della Valle
2, 3, 29
,
Enrique Goytizolo
1, 2, 3
,
Zhenggang Guo
30, 31
,
Rosemary Hogg
32, 33
,
Henrik Kehlet
34, 35
,
Paul Kessler
36, 37
,
Sandra L Kopp
10, 11
,
Patricia Lavand’homme
17, 38
,
Alan Macfarlane
39, 40
,
Catherine MacLean
2, 3, 41
,
Carlos Mantilla
10, 11
,
Dan McIsaac
42, 43
,
Alexander Mclawhorn
2, 3, 29
,
J. M. Neal
17, 44, 45
,
Michael Parks
2, 46
,
Javad Parvizi
46, 47
,
Philip Peng
48, 49
,
Lukas Pichler
4, 5
,
Jashvant Poeran
50, 51
,
Lazaros Poultsides
52, 53
,
Eric S. Schwenk
30, 54
,
Brian D. Sites
17, 55
,
Ottokar Stundner
4, 5, 56, 57
,
Eric C. Sun
8, 9
,
Eugene R. Viscusi
30, 58
,
Effrossyni Gina Votta Velis
30, 59
,
C. K. Wu
1, 2, 3
,
Jacques Yadeau
1, 2, 3
,
NIGEL E. SHARROCK
1, 2, 3
1
Department of Anesthesiology, Critical Care and Pain Management
2
HOSPITAL FOR SPECIAL SURGERY
4
Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine
5
Paracelsus Medical Private University
6
Anesthesiology and Perioperative Care Service
7
VA Palo Alto Health Care System
|
8
Department of Anesthesiology, Perioperative and Pain Medicine
10
Department of Anesthesiology & Perioperative Medicine
12
Nuffield Department of Anaesthetics
14
Faculty of Medicine
15
Aretaieion University Hospital
17
Anesthesiology
19
Anesthesia, Critical Care and Multidisciplinary Pain Management Department
21
Anesthesia Unit, Surgical Specialties Department
23
Anaesthesia
24
Guy's and St Thomas' NHS Foundation Trust
25
Anesthesiology and Critical Care
27
Department of Anesthesiology and Resuscitation
28
Clinique Sainte-Anne Saint-Remi
29
Department of Orthopedic Surgery
30
Department of Anesthesiology
32
Department of Anaesthesia
33
Belfast Health and Social Care Trust
34
Department of Clinical Medicine
35
Rigshosp
36
Anaesthesiology, Intensive Care Medicine and Pain Therapy
38
St Luc Hospital, University Catholic of Louvain
39
School of Medicine, Dentistry & Nursing
40
Glasgow Royal Infirmary and Stobhill Ambulatory Hospital
|
41
Center for the Advancement of Value in Musculoskeletal Care
42
Department of Anesthesiology and Pain Medicine
44
Virginia Mason Medical Center
|
45
Benaroya Research Institute
46
Orthopedic Surgery
47
Rothman Orthopaedic Institute
48
Anesthesia
50
Orthopaedics/Population Health Science & Policy
|
52
Department of Orthopaedic Surgery
53
New York Langone Orthopaedic Hospital
|
56
Department of Anesthesiology and Intensive Care
Publication type: Journal Article
Publication date: 2021-08-25
scimago Q1
wos Q1
SJR: 1.411
CiteScore: 9.6
Impact factor: 3.5
ISSN: 10987339, 15328651
PubMed ID:
34433647
General Medicine
Anesthesiology and Pain Medicine
Abstract
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.
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Memtsoudis S. G. et al. 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 // Regional Anesthesia and Pain Medicine. 2021. Vol. 46. No. 11. pp. 971-985.
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Memtsoudis S. G. et al. 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 // Regional Anesthesia and Pain Medicine. 2021. Vol. 46. No. 11. pp. 971-985.
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@article{2021_Memtsoudis,
author = {Stavros G Memtsoudis and Crispiana Cozowicz and Janis Bekeris and Dace Bekere and Jiabin Liu and Ellen M. Soffin and Edward R. Mariano and Rebecca L. Johnson and GEORGE GO and MARY JEAN HARGETT and Bradley H. Lee and Pamela Wendel and Mark Brouillette and Sang Jo Kim and Lila Baaklini and Douglas S. Wetmore and Genewoo Hong and Rie Goto and Bridget Jivanelli and Vassilis Athanassoglou and Eriphili Argyra and Michael J. Barrington and Alain Borgeat and Jose De Andres and Kariem El-Boghdadly and Nabil Elkassabany and Philippe Gautier and Peter Gerner and Alejandro Gonzalez Della Valle and Enrique Goytizolo and Zhenggang Guo and Rosemary Hogg and Henrik Kehlet and Paul Kessler and Sandra L Kopp and Patricia Lavand’homme and Alan Macfarlane and Catherine MacLean and Carlos Mantilla and Dan McIsaac and Alexander Mclawhorn and J. M. Neal and Michael Parks and Javad Parvizi and Philip Peng and Lukas Pichler and Jashvant Poeran and Lazaros Poultsides and Eric S. Schwenk and Brian D. Sites and others},
title = {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},
journal = {Regional Anesthesia and Pain Medicine},
year = {2021},
volume = {46},
publisher = {Ovid Technologies (Wolters Kluwer Health)},
month = {aug},
url = {https://doi.org/10.1136/rapm-2021-102750},
number = {11},
pages = {971--985},
doi = {10.1136/rapm-2021-102750}
}
Cite this
MLA
Copy
Memtsoudis, Stavros G., et al. “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.” Regional Anesthesia and Pain Medicine, vol. 46, no. 11, Aug. 2021, pp. 971-985. https://doi.org/10.1136/rapm-2021-102750.
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