International consensus on anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia

James Simeon Bowness, Amit Pawa, Lloyd Turbitt, Boyne Bellew, Nigel Bedforth, David Burckett-St Laurent, Alain Delbos, Nabil Elkassabany, Jenny Ferry, Ben Fox, James L H French, Calum Grant, Ashwani Gupta, William Harrop-Griffiths, Nat Haslam, Helen Higham, Rosemary Hogg, David F Johnston, Rachel Joyce Kearns, Sandra Kopp, Clara Lobo, Sonya McKinlay, Stavros Memtsoudis, Peter Merjavy, Eleni Moka, Madan Narayanan, Samer Narouze, J Alison Noble, David Phillips, Meg Rosenblatt, Amy Sadler, Maria Paz Sebastian, Alasdair Taylor, Athmaja Thottungal, Luis Fernando Valdés-Vilches, Thomas Volk, Simeon West, Morné Wolmarans, Jonathan Womack, Alan James Robert Macfarlane

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.