Bowness James Simeon, Pawa Amit, Turbitt Lloyd, Bellew Boyne, Bedforth Nigel, Burckett-St Laurent David, Delbos Alain, Elkassabany Nabil, Ferry Jenny, Fox Ben, French James L H, Grant Calum, Gupta Ashwani, Harrop-Griffiths William, Haslam Nat, Higham Helen, Hogg Rosemary, Johnston David F, Kearns Rachel Joyce, Kopp Sandra, Lobo Clara, McKinlay Sonya, Memtsoudis Stavros, Merjavy Peter, Moka Eleni, Narayanan Madan, Narouze Samer, Noble J Alison, Phillips David, Rosenblatt Meg, Sadler Amy, Sebastian Maria Paz, Taylor Alasdair, Thottungal Athmaja, Valdés-Vilches Luis Fernando, Volk Thomas, West Simeon, Wolmarans Morné, Womack Jonathan, Macfarlane Alan James Robert
OxSTaR, Oxford University, Oxford, UK
Department of Anaesthesia, Aneurin Bevan Health Board, Newport, UK.
Reg Anesth Pain Med. 2022 Feb;47(2):106-112. doi: 10.1136/rapm-2021-103004. Epub 2021 Sep 22.
There is no universally agreed set of anatomical structures that must be identified on ultrasound for the performance of ultrasound-guided regional anesthesia (UGRA) techniques. This study aimed to produce standardized recommendations for core (minimum) structures to identify during seven basic blocks. An international consensus was sought through a modified Delphi process. A long-list of anatomical structures was refined through serial review by key opinion leaders in UGRA. All rounds were conducted remotely and anonymously to facilitate equal contribution of each participant. Blocks were considered twice in each round: for "orientation scanning" (the dynamic process of acquiring the final view) and for the "block view" (which visualizes the block site and is maintained for needle insertion/injection). Strong recommendations for inclusion were made if ≥75% of participants rated a structure as "definitely include" in any round. Weak recommendations were made if >50% of participants rated a structure as "definitely include" or "probably include" for all rounds (but the criterion for "strong recommendation" was never met). Thirty-six participants (94.7%) completed all rounds. 128 structures were reviewed; a "strong recommendation" is made for 35 structures on orientation scanning and 28 for the block view. A "weak recommendation" is made for 36 and 20 structures, respectively. This study provides recommendations on the core (minimum) set of anatomical structures to identify during ultrasound scanning for seven basic blocks in UGRA. They are intended to support consistent practice, empower non-experts using basic UGRA techniques, and standardize teaching and research.
对于超声引导区域麻醉（UGRA）技术而言，目前尚无一套普遍认可的、必须在超声下识别的解剖结构。本研究旨在为七种基本阻滞过程中需识别的核心（最少）结构制定标准化建议。通过改良的德尔菲法寻求国际共识。一份长长的解剖结构清单经UGRA领域关键意见领袖的系列审查得以完善。所有轮次均通过远程且匿名的方式进行，以促进每位参与者平等贡献意见。在每一轮中，对每种阻滞均从两个方面进行考量：“定位扫描”（获取最终图像的动态过程）和“阻滞图像”（显示阻滞部位并在进针/注射时保持的图像）。如果在任何一轮中，≥75%的参与者将某一结构评为“肯定包含”，则给出纳入的强烈推荐。如果>50%的参与者在所有轮次中将某一结构评为“肯定包含”或“可能包含”（但未达到“强烈推荐”的标准），则给出弱推荐。36名参与者（94.7%）完成了所有轮次。共审查了128种结构；对于定位扫描，对35种结构给出“强烈推荐”，对于阻滞图像，对28种结构给出“强烈推荐”。对于定位扫描和阻滞图像，分别对36种和20种结构给出“弱推荐”。本研究提供了关于UGRA中七种基本阻滞超声扫描时需识别的核心（最少）解剖结构集的建议。这些建议旨在支持一致的操作，使使用基本UGRA技术的非专家能够胜任，并规范教学与研究。
