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An International Delphi Consensus Study

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An International Delphi Consensus Study BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Reg Anesth Pain Med Standardising nomenclature in regional anaesthesia: an international Delphi consensus study This document includes all of the results from the first, second, and third round Delphi study, as well as the final results ROUND 1 RESULTS ROUND 1 CHANGES IMPLEMENTED ROUND 2 RESULTS ROUND 2 CHANGES IMPLEMENTED CLARIFYING QUESTIONS ROUND 2 RESULTS ROUND 3 RESULTS RESULTS FINAL RESULTS El-Boghdadly K, et al. Reg Anesth Pain Med 2021; 46:571–580. doi: 10.1136/rapm-2020-102451 BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Reg Anesth Pain Med BACK TO CONTENTS REGION Name Anatomical description Comments 1 Rectus sheath block Injection the plane between the rectus abdominis muscle and posterior rectus sheath Injection in proximity to the ilioinguinal and iliohypogastric nerves, located within the plane 2 Ilioinguinal iliohypogastric nerves block between the internal oblique and transversus abdominis muscles in the lower quadrants of the anterior abdominal wall 3 Transversus abdominis plane block Injection the plane between the internal oblique and transversus abdominis muscles Injection the plane between the internal oblique and transversus abdominis muscles at the Mid-axillary transversus abdominis plane block 4 mid-axillary line Injection the plane between the internal oblique and transversus abdominis muscles along the Subcostal transversus abdominis plane block 5 medial costal margin in the upper quadrants of the anterior abdominal wall 6 Anterior quadratus lumborum block Injection the plane between quadratus lumborum and psoas major muscles Injection the plane between the aponeuroses of internal oblique and transversus abdominis Lateral quadratus lumborum block 7 muscles at the lateral border of the quadratus lumborum muscle Injection the plane between the quadratus lumborum and erector spinae muscles, on the Posterior quadratus lumborum block 8 posterior surface of quadratus lumborum muscle 9 Transversalis fascia plane block Injection the plane between the transversus abdominis and the transversalis fascia 10 Rhomboid intercostal plane block Injection the plane between the rhomboid major and intercostal muscles 69% agreement with the name; 81% agreement with description Injection in the paravertebral space (between the superior costo-transverse ligament and Paravertebral block 11 parietal pleura) in the thoracic region Injection in the tissue between two transverse processes, posterior to the superior costo- ITP: 58% Inter-transverse process block transverse ligament or half way between the posterior aspect of the transverse process and 12 MTP: 42% the pleura. 13 Erector spinae plane block Injection in the plane between the erector spinae muscles and the transverse process PARASPINAL 14 Retrolaminar block Injection in the plane between the erector spinae muscles and the lamina 15 Superficial serratus anterior plane block Injection the plane between pectoralis major and serratus anterior muscles Discuss: clarification required, remove reference to other muscles from description Injection the plane between the posterior surface of the serratus anterior muscle and the Deep serratus anterior plane block 16 periosteum of the rib Injection the plane superficial to the internal intercostal muscles and ribs and deep to the Superficial parasternal intercostal plane block 17 pectoralis major muscle Injection the plane between the internal intercostal muscle and the transversus thoracis Deep parasternal intercostal plane block 18 muscle CHEST WALL CHEST 19 PECS I ABDOMINALWALL Injection the plane between the pectoralis major and pectoralis minor muscles 73% agreement with interpectoral plane block 20 PECS II Injection in plane between the pectoralis minor and serratus anterior muscles 53% agreement with pecto-serratus plane block El-Boghdadly K, et al. Reg Anesth Pain Med 2021; 46:571–580. doi: 10.1136/rapm-2020-102451 BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Reg Anesth Pain Med BACK TO CONTENTS QUESTION OPTIONS AGREEMENT 1 TAP block: For this anatomical description, should this Lateral transversus abdominis plane block 11% technique be named: Mid-axillary transversus abdominis plane block 89% 2 Transversus abdominis plane block / QL block / Harmonise all three. 27% transversalis fascia plane block: For this anatomical Harmonise posterior transversus abdominis and lateral quadratus lumborum blocks 73% 3 Harmonise TAP and QL. What name should the Posterior transversus abdominis plane block 20% harmonised two blocks take? Lateral quadratus lumborum block 80% 4 Inter-transverse process block: Should the STIL, MTP, Yes 84% MIC, CTF blocks techniques be harmonised to the inter- No 16% 5 Yes. Should the anatomical description of the inter- Yes 43% transverse process block be accepted? No 57% 6 Should the anatomical description of the MTP / ITP Yes 86% blocks be “injection in the tissues between 2 transverse No 14% 7 Should this block be named the inter-transverse process inter-transverse process block 58% block or the mid-point transverse process to pleura block? MTP block 42% 8 Lumbar multifidus plane block: Should the thoracolumbar Yes 64% interfascial plane block (TLIP) be named the lumbar No 36% 9 Lumbar multifidus plane block: Should this anatomical Yes 40% description be used for the thoracolumbar interfascial No 60% 10 Lumbar longissimus plane block: Should the modified Yes 39% thoracolumbar interfascial plane block (TLIP) be named No 61% 11 Lumbar longissimus plane block: Should these Yes 48% anatomical descriptions be used for the modified No 52% 12 Rhomboid intercostal plane block: Should this block Yes 69% approach be named the rhomboid intercostal plane block? No 31% 13 Rhomboid intercostal plane block: Should this anatomical Yes 81% description be accepted? No 19% 14 Deep serratus anterior plane block: Should this Yes 91% anatomical description be named the deep serratus No 9% 15 Superficial serratus anterior plane block: Should this Yes 80% anatomical description be named the deep serratus No 20% 16 Superficial serratus anterior plane block: Should the Injection in the plane between pectoralis major and serratus anterior muscles 2% anatomical description of the superficial serratus anterior Injection in the plane superficial to the serratus anterior muscles 52% plane block be: Between serratus anterior and latissimus dorsi 46% 17 Deep parasternal intercostal plane block: Should this Yes 85% anatomical description be named deep parasternal No 15% 18 Superficial parasternal intercostal plane block: Should Yes 90% this anatomical description be named superficial No 10% 19 Interpectoral plane block: Should this anatomical Yes 73% description be named interpectoral plane block? No 27% 20 Should the anatomical description used for the PECS I / Yes 56% inter pectoral plane block be named the superficial No 44% 21 Pecto-serratus plane block: Should this anatomical Yes 53% description be named the pecto-serratus plane block? No 47% 22 Pecto-serratus plane and superficial serratus anterior Yes, they are the same. Harmonise them. 51% plane block: Are the anatomical locations of injection for No, they are different. Do not harmonise them. 49% 23 Should the anatomical description used for the PECS II / Yes 46% pecto-serratus plane block be named the superficial No 54% 24 Planes: What term should be used to describe the Fascial plane 78% superficial, deep or muscle-related planes composed of Interfascial plane 22% El-Boghdadly K, et al. Reg Anesth Pain Med 2021; 46:571–580. doi: 10.1136/rapm-2020-102451 BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Reg Anesth Pain Med BACK TO NAME DESCRIPTION CONTENTS OVERALL OVERALL REGION NOTES NAME Agreement Disagreement Unsure DESCRIPTION (anatomical location of injection) Agree Disagree Unsure Injection in proximity to the ilioinguinal and iliohypogastric nerves, located within the plane 1 Ilioinguinal iliohypogastric nerves block 91% 5% 3% between the internal oblique and transversus abdominis muscles in the lower quadrants of 93% 4% 4% the anterior abdominal wall 2 Transversus abdominis plane block 95% 2% 4% Injection the plane between the internal oblique and transversus abdominis muscles 95% 5% 0% Injection the plane between the internal oblique and transversus abdominis muscles at the 3A and B: 3 A Lateral transversus abdominis plane block 34% 57% 9% 76% 18% 6% SAME BLOCK APPROACH, mid-axillary line DIFFERENT NAME. WHICH NAME DO YOU AGREE Injection the plane between the internal oblique and transversus abdominis muscles at the WITH MORE? Mid-axillary transversus abdominis plane block 67% 30% 4% 81% 15% 4% B mid-axillary line Injection the plane between the internal oblique and tapering posterior end of transverse Posterior transversus abdominis plane block 61% 21% 18% 82% 7% 11% 4 abdominis. Injection the plane between the internal oblique and transversus abdominis muscles along Subcostal transversus abdominis
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