02 PERSEUS USGRA Appendices

Appendix 1.
SEARCH STRATEGY
PICO 13
B1.
Population/problem
Patients requiring anaesthesia or analgesia in the distribution of interscalene brachial plexus block
Intervention
Ultrasound-guided interscalene brachial plexus block
Comparators
Any other technique of interscalene brachial plexus block
Outcomes
Adequacy of anaesthesia for intended surgery
Adequacy of postoperative analgesia
Time to perform block
Time to achieve effective block
Dose of local anaesthetic required
Incidence of complications:
Nerve damage
Systemic local anaesthetic toxicity
Phrenic nerve palsy
Inadvertent spinal/epidural
Pneumothorax
Patient discomfort during procedure
Patient satisfaction with procedure
Situation
Any elective situation
Search date: 6. March 2017
PubMed
Interscalene[Text Word]
AND
"Brachial Plexus Block"[Mesh Terms] OR (("Brachial Plexus"[Mesh Terms] OR Brachial Plexus*[Text Word]) AND ("Nerve
Block"[Mesh Terms] OR block*[Text Word] OR anaesth*[Text Word] OR anesth*[Text Word]))
AND
"ultrasonography"[MeSH Terms] OR ultrasound*[Title/Abstract] OR ultrasonograph*[Title/Abstract] OR ultra
sound*[Title/Abstract] OR (echograph*[Title/Abstract] AND (anaesth*[Title/Abstract] OR anesth*[Title/Abstract]))
NOT (“animals"[MeSH Terms] not “humans"[MeSH Terms])
Filters: Publication date from 2005/01/01 to 2017/12/31
Search (((Interscalene[Text Word]) AND ("Brachial Plexus Block"[Mesh Terms] OR (("Brachial Plexus"[Mesh Terms] 186
OR Brachial Plexus*[Text Word]) AND ("Nerve Block"[Mesh Terms] OR block*[Text Word] OR anaesth*[Text Word]
OR anesth*[Text Word])))) AND ("ultrasonography"[MeSH Terms] OR ultrasound*[Title/Abstract] OR
ultrasonograph*[Title/Abstract] OR ultra sound*[Title/Abstract] OR (echograph*[Title/Abstract] AND
(anaesth*[Title/Abstract] OR anesth*[Title/Abstract])))) NOT ((“animals"[MeSH Terms] not “humans"[MeSH
Terms])) Filters: Publication date from 2005/01/01 to 2017/12/31
Embase
1 Interscalene.af. (1705)
2 exp brachial plexus anesthesia/ or ((exp brachial plexus/ or brachial plexus*.mp.) and (exp nerve block/ or block*.mp.
or an?esth*.mp.)) [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug
manufacturer, device trade name, keyword, floating subheading] (7807)
3 exp ultrasound/ or (ultrasound* or ultra sound* or ultrasonograph* or (echograph* and an?esth*)).ti,ab. (433159)
4 1 and 2 and 3 (440)
5 exp animal/ not exp human/ (4516428)
6 4 not 5 (440)
7 limit 6 to yr="2005 -Current" (429)
Central
#1 Interscalene 366
#2 MeSH descriptor: [Brachial Plexus Block] explode all trees 43
#3 MeSH descriptor: [Brachial Plexus] explode all trees 924
#4 Brachial Plexus* 1210
#5 #3 or #4 1640
#6 MeSH descriptor: [Nerve Block] explode all trees 3218
#7 block* or an*esth* 122871
#8 #6 or #7 122871
#9 #5 and #8 1207
#10 #2 or #9 1207
#11 MeSH descriptor: [Ultrasonography] explode all trees 9528
#12 (ultrasound* or ultra sound* or ultrasonograph* or (echograph* and an*esth*)) 25341
#13 #11 or #12 27594
#14 #1 and #10 and #13 96
#15 #14 Publication Year from 2005 to 2017, in Trials 88
Cinahl
S1 Interscalene 196
(MH "Brachial Plexus Block") OR ((MH "Brachial Plexus+") OR Brachial Plexus*) AND ((MH "Nerve
S2 Block+") OR block* OR an*esth*)) 1,706
S3 S1 AND S2 126
S4 (MH "Ultrasonography+") 35,830
S5 TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph* AND an*esth*)) 47,050
S6 S4 OR S5 57,337
S7 S3 AND S6 50
S8 (MH "Animals+") not (MH "Human") 31,176
S9 S7 not S8 50
S10 S7 not S8 Published: 20050101-20171231 48

PICO 14
B2. Population/problem
Patients requiring anaesthesia in the distribution of supraclavicular brachial plexus block
Intervention
Ultrasound-guided supraclavicular brachial plexus block
Comparators
Any other technique of supraclavicular brachial plexus block
Outcomes
Adequacy of analgesia for tourniquet tolerance
Nerve damage
Vascular puncture
Haematoma
Phrenic nerve palsy
Pneumothorax
Situation
Search date: 6. march 2017
PubMed
supraclavicular[Text Word]
AND
AND
Search (((supraclavicular[Text Word]) AND ("Brachial Plexus Block"[Mesh Terms] OR (("Brachial Plexus"[Mesh 168
Terms] OR Brachial Plexus*[Text Word]) AND ("Nerve Block"[Mesh Terms] OR block*[Text Word] OR anaesth*[Text
Word] OR anesth*[Text Word])))) AND ("ultrasonography"[MeSH Terms] OR ultrasound*[Title/Abstract] OR
Embase
1 supraclavicular.af. (7286)
4 1 and 2 and 3 (412)
6 4 not 5 (412)
Central
#1 supraclavicular 465
#5 #3 or #4 1640
#8 #6 or #7 122871
#9 #5 and #8 1207
#10 #2 or #9 1207
#13 #11 or #12 27594
#14 #1 and #10 and #13 90
Cinahl
S1 supraclavicular 313
S3 S1 AND S2 90
S6 S4 OR S5 57,337
S7 S3 AND S6 55
S9 S7 not S8 55
PICO 15
Patients requiring anaesthesia in the distribution of infraclavicular brachial plexus block
Intervention
Ultrasound-guided infraclavicular brachial plexus block
Comparators
Any other technique of infraclavicular brachial plexus block
Outcomes
Nerve damage
Vascular puncture
Haematoma
Phrenic nerve palsy
Pneumothorax
Situation
PubMed
infraclavicular*[Text Word]
AND
AND
Search (((infraclavicular*[Text Word]) AND ("Brachial Plexus Block"[Mesh Terms] OR (("Brachial Plexus"[Mesh 135
Terms] OR Brachial Plexus*[Text Word]) AND ("Nerve Block"[Mesh Terms] OR block*[Text Word] OR anaesth*[Text
Word] OR anesth*[Text Word])))) AND ("ultrasonography"[MeSH Terms] OR ultrasound*[Title/Abstract] OR
Embase
1 infraclavicular*.af. (1607)
4 1 and 2 and 3 (261)
6 4 not 5 (260)
Central
#1 infraclavicular* 237
#5 #3 or #4 1640
#8 #6 or #7 122871
#9 #5 and #8 1207
#10 #2 or #9 1207
#13 #11 or #12 27594
#14 #1 and #10 and #13 80
Cinahl
S1 infraclavicular* 133
S3 S1 AND S2 68
S6 S4 OR S5 57,337
S7 S3 AND S6 42
S9 S7 not S8 42
PICO 16
Patients requiring anaesthesia in the distribution of axillary brachial plexus block
Intervention
Ultrasound-guided axillary brachial plexus block
Comparators
Any other technique of axillary brachial plexus block
Outcomes
Nerve damage
Vascular puncture
Haematoma
Situation
PubMed
axillar*[Text Word]
AND
AND
Search (((axillar*[Text Word]) AND ("Brachial Plexus Block"[Mesh Terms] OR (("Brachial Plexus"[Mesh Terms] OR 220
Brachial Plexus*[Text Word]) AND ("Nerve Block"[Mesh Terms] OR block*[Text Word] OR anaesth*[Text Word] OR
anesth*[Text Word])))) AND ("ultrasonography"[MeSH Terms] OR ultrasound*[Title/Abstract] OR
Embase
1 axillar*.af. (46993)
4 1 and 2 and 3 (476)
6 4 not 5 (468)
Central
#1 axillar* 2987
#5 #3 or #4 1640
#8 #6 or #7 122871
#9 #5 and #8 1207
#10 #2 or #9 1207
#13 #11 or #12 27594
#14 #1 and #10 and #13 117
Cinahl
S1 axillar* 2,324
S3 S1 AND S2 160
S6 S4 OR S5 57,350
S7 S3 AND S6 44
S9 S7 not S8 44

PICO 18
B6. Patients requiring a sciatic block
Population/problem
Patients requiring a sciatic nerve block
Intervention
Ultrasound-guided sciatic nerve block using any approach
Comparators
Any other technique of sciatic nerve block
Outcomes
Adequacy of sciatic nerve block
Nerve damage
Vascular puncture
Haematoma
PubMed
Sciatic*[Text Word] OR "Sciatic Nerve"[Mesh]

AND
("Anesthesia, Local"[Mesh]) OR "Nerve Block"[Mesh] OR block*[Title/Abstract] OR ((regional*[Title/Abstract] OR
local*[Title/Abstract]) AND (anaesth*[Title/Abstract] OR anesth*[Title/Abstract]))
AND
Search (((((Sciatic*[Text Word] OR "Sciatic Nerve"[Mesh]))) AND (("Anesthesia, Local"[Mesh]) OR "Nerve 352
Block"[Mesh] OR block*[Title/Abstract] OR ((regional*[Title/Abstract] OR local*[Title/Abstract]) AND
(anaesth*[Title/Abstract] OR anesth*[Title/Abstract])))) AND ("ultrasonography"[MeSH Terms] OR
ultrasound*[Title/Abstract] OR ultrasonograph*[Title/Abstract] OR ultra sound*[Title/Abstract] OR
(echograph*[Title/Abstract] AND (anaesth*[Title/Abstract] OR anesth*[Title/Abstract])))) NOT ((“animals"[MeSH
Terms] not “humans"[MeSH Terms])) Filters: Publication date from 2005/01/01 to 2017/12/31
Embase
1 sciatic nerve/ or sciatic*.mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer,
drug manufacturer, device trade name, keyword, floating subheading] (36564)
2 exp regional anesthesia/ or block*.ti,ab. or ((local* or regional*) adj5 an?esth*).ti,ab. (893853)
4 1 and 2 and 3 (791)
6 4 not 5 (758)
Central
#1 sciatic* 1357
#2 MeSH descriptor: [Sciatic Nerve] explode all trees 544
#3 MeSH descriptor: [Anesthesia, Local] explode all trees 1959
#5 block* or ((local* or regional*) near/5 an*esth*) 63961
#6 #1 or #2 1655
#7 #3 or #4 or #5 63961
#8 #6 and #7 676
#11 #9 or #10 27594
#12 #8 and #11 213
Cinahl
S1 (MH "Sciatic Nerve+") or TX (sciatic*) 2,700
(MM ”Anesthesia, Local“) OR (MM ”Nerve Block“) OR TX (block* or ((local* OR regional*) N5

S2 an*esth*)) 54,558
(MH "Ultrasonography+") or TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph*

S3 AND an*esth*)) 57,350
S4 S1 AND S2 AND S3 116
S6 S4 not S5 115

PICO 19
B7. Patients requiring analgesia of the trunk
Population/problem
Patients requiring postoperative analgesia of the trunk
Intervention
Non-neuraxial regional techniques of the trunk dependent on ultrasound guidance, e.g., TAP block, PECS blocks
Comparators
Systemic analgesia, neuraxial or paravertebral regional anaesthesia
Outcomes
Quality of analgesia
Incidence of complications of regional technique:
Nerve damage
Vascular puncture
Pneumothorax
Haematoma
Dural puncture
Postoperative nausea and vomiting
Incidence of urinary retention
Time to postoperative mobilisation
Time to discharge
PubMed
Trunk*[Title/Abstract] OR torso*[Title/Abstract] OR abdom*[Title/Abstract] OR pelvis*[Title/Abstract] OR

rectus[Title/Abstract] OR PECS[Title/Abstract] OR TAP[Title/Abstract] OR ilio*[Title/Abstract] OR psoas[Title/Abstract] OR
serratus anterior*[Title/Abstract] OR transverse abdominal*[Title/Abstract] OR "Torso"[Mesh] OR "Abdominal
Muscles"[Mesh] OR "Rectus Abdominis"[Mesh] OR "Psoas Muscles"[Mesh]
AND
AND
Search (((((Trunk*[Title/Abstract] OR torso*[Title/Abstract] OR abdom*[Title/Abstract] OR pelvis*[Title/Abstract] 1019

OR rectus[Title/Abstract] OR PECS[Title/Abstract] OR TAP[Title/Abstract] OR ilio*[Title/Abstract] OR
psoas[Title/Abstract] OR serratus anterior*[Title/Abstract] OR transverse abdominal*[Title/Abstract] OR
"Torso"[Mesh] OR "Abdominal Muscles"[Mesh] OR "Rectus Abdominis"[Mesh] OR "Psoas Muscles"[Mesh]))) AND
(("Anesthesia, Local"[Mesh]) OR "Nerve Block"[Mesh] OR block*[Title/Abstract] OR ((regional*[Title/Abstract] OR
local*[Title/Abstract]) AND (anaesth*[Title/Abstract] OR anesth*[Title/Abstract])))) AND ("ultrasonography"[MeSH
Terms] OR ultrasound*[Title/Abstract] OR ultrasonograph*[Title/Abstract] OR ultra sound*[Title/Abstract] OR
Embase
1 exp trunk/ or rectus abdominis muscle/ or psoas muscle/ or (trunk* or torso* or abdom* or pelvis* or rectus or PECS
or TAP or ilio* or psoas or serratus anterior* or transverse abdominal*).ti,ab. (553707)
4 1 and 2 and 3 (2409)
6 4 not 5 (2341)
Central
#1 trunk* or torso* or abdom* or pelvis* or rectus or PECS or TAP or ilio* or psoas or serratus anterior* or
transverse abdominal* 35103
#2 MeSH descriptor: [Torso] explode all trees 4771
#3 MeSH descriptor: [Abdominal Muscles] explode all trees 795
#4 MeSH descriptor: [Rectus Abdominis] explode all trees 62
#5 MeSH descriptor: [Psoas Muscles] explode all trees 38
#9 #1 or #2 or #3 or #4 or #5 36937
#10 #6 or #7 or #8 63967
#11 #9 and #10 5011
#14 #12 or #13 27596
#15 #11 and #14 990
Cinahl
(MH "Torso") OR (MH "Abdomen+") OR (MH "Rectus Abdominis Muscles") OR (MH "Abdominal
Muscles+") OR (MH "Psoas Muscles") OR (MH "Serratus Anterior Muscles") OR TX (trunk* OR torso*
OR abdom* OR pelvis* OR rectus OR PECS OR TAP OR ilio* OR psoas OR serratus anterior* OR
S1 transverse abdominal*) 39,716
(MM ”Anesthesia, Local“) OR (MM ”Nerve Block“) OR TX (block* OR ((local* OR regional*) N5

S2 an*esth*)) 54,573
(MH "Ultrasonography+") OR TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph*


S6 S4 not S5 179

PICO 20
B8. Patients requiring a femoral block
Population/problem
Patients requiring a femoral nerve block
Intervention
Ultrasound-guided femoral nerve block
Comparators
Any other technique of femoral nerve block
Outcomes
Adequacy of femoral nerve block
Nerve damage
Vascular puncture
Haematoma
PubMed
(femoral*[Text Word] AND nerve*[Text Word]) OR "Femoral Nerve"[Mesh]

AND
AND
Search ((((((femoral*[Text Word] AND nerve*[Text Word]) OR "Femoral Nerve"[Mesh]))) AND (("Anesthesia, 322
Local"[Mesh]) OR "Nerve Block"[Mesh] OR block*[Title/Abstract] OR ((regional*[Title/Abstract] OR
Embase
1 femoral nerve/ or (femoral* adj5 nerve*).mp. [mp=title, abstract, heading word, drug trade name, original title, device
manufacturer, drug manufacturer, device trade name, keyword, floating subheading] (6156)
4 1 and 2 and 3 (700)
6 4 not 5 (686)
Central
#1 femoral* near/5 Nerve* 773

#2 MeSH descriptor: [Femoral Nerve] explode all trees 323
#6 #1 or #2 773
#7 #3 or #4 or #5 63961
#8 #6 and #7 700
#11 #9 or #10 27594
#12 #8 and #11 166
Cinahl
S1 (MH "Femoral Nerve") or TX (femoral* N5 nerve*) 644

S2 an*esth*)) 54,558

S6 S4 not S5 81

PICO 21
B9. Patients requiring a popliteal block
Population/problem
Patients requiring a popliteal block
Intervention
Ultrasound-guided popliteal nerve block
Comparators
Any other technique of popliteal nerve block
Outcomes
Adequacy of popliteal nerve block
Nerve damage
Vascular puncture
Haematoma
PubMed
"Popliteal Vein"[Mesh] OR "Popliteal Artery"[Mesh] OR Popliteal*[Text Word]

AND
AND
Search ((((("Popliteal Vein"[Mesh] OR "Popliteal Artery"[Mesh] OR Popliteal*[Text Word]))) AND (("Anesthesia, 154
Local"[Mesh]) OR "Nerve Block"[Mesh] OR block*[Title/Abstract] OR ((regional*[Title/Abstract] OR
Embase
1 exp popliteal vein/ or exp popliteal artery/ or popliteal.mp. [mp=title, abstract, heading word, drug trade name,
original title, device manufacturer, drug manufacturer, device trade name, keyword, floating subheading] (21442)
4 1 and 2 and 3 (415)
6 4 not 5 (414)
Central
#1 MeSH descriptor: [Popliteal Artery] explode all trees 335

#2 MeSH descriptor: [Popliteal Vein] explode all trees 66
#3 Popliteal* 1105
#4 #1 or #2 or #3 1105
#8 #5 or #6 or #7 63961
#11 #9 or #10 27594
#12 #4 and #8 and #11 161
Cinahl
S1 (MH "Popliteal Vein") OR (MH "Popliteal Artery") or TX Popliteal* 838

S2 an*esth*)) 54,558
(MH "Ultrasonography+") or TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR

S3 (echograph* AND an*esth*)) 57,350
S6 S4 not S5 39

PICO 23
C1. Paravertebral blocks
Population/problem
Patients requiring paravertebral injection/catheter
Intervention
Ultrasound-guided paravertebral block
Comparators
Any other technique of paravertebral block
Outcomes
Adequacy of analgesia
Time to perform paravertebral
Nerve damage
Vascular puncture
Inadvertent epidural
pneumothorax
Search date: 8 march 2017
PubMed
paravertebral*
AND
AND
Search (((paravertebral*) AND (("Anesthesia, Local"[Mesh]) OR "Nerve Block"[Mesh] OR block*[Title/Abstract] OR 157

((regional*[Title/Abstract] OR local*[Title/Abstract]) AND (anaesth*[Title/Abstract] OR anesth*[Title/Abstract]))))
AND ("ultrasonography"[MeSH Terms] OR ultrasound*[Title/Abstract] OR ultrasonograph*[Title/Abstract] OR ultra
sound*[Title/Abstract] OR (echograph*[Title/Abstract] AND (anaesth*[Title/Abstract] OR anesth*[Title/Abstract]))))
NOT ((“animals"[MeSH Terms] not “humans"[MeSH Terms])) Filters: Publication date from 2005/01/01 to
2017/12/31
Embase
1 paravertebral*.mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug
4 1 and 2 and 3 (422)
6 4 not 5 (418)
Central
#1 paravertebral* 530
#5 #2 or #3 or #4 63966
#6 #1 and #5 370
#9 #7 or #8 27596
#10 #6 and #9 78
Cinahl
S1 paravertebral* 314

S2 an*esth*)) 54,558

S6 s4 not s5 26
S7 s4 not s5 Published: 20050101-20171231 24

PICO 24
C2. Epidural anaesthesia
Population/problem
Patients requiring siting of an epidural catheter
Intervention
Ultrasound-guided epidural
Comparators
Any other technique of epidural catheter insertion
Outcomes
Adequacy of epidural analgesia
Time to perform epidural
Nerve damage
Vascular puncture
Dural puncture
Epidural haematoma
Post-procedural back pain
Search date: 8. march 2017
PubMed
"Analgesia, Epidural"[Mesh] OR "Injections, Epidural"[Mesh] OR "Anesthesia, Epidural"[Mesh] OR

((epidural*[Title/Abstract] OR peridural*[Title/Abstract] OR extradural*[Title/Abstract] OR subarachnoid*[Title/Abstract]
OR intrathecal*[Title/Abstract] OR neuraxial*[Title/Abstract]) AND (catheter*[Title/Abstract] OR cannula*[Title/Abstract]))
AND
Search (((("Analgesia, Epidural"[Mesh] OR "Injections, Epidural"[Mesh] OR "Anesthesia, Epidural"[Mesh] OR 452

((epidural*[Title/Abstract] OR peridural*[Title/Abstract] OR extradural*[Title/Abstract] OR
subarachnoid*[Title/Abstract] OR intrathecal*[Title/Abstract] OR neuraxial*[Title/Abstract]) AND
(catheter*[Title/Abstract] OR cannula*[Title/Abstract]))))) AND ("ultrasonography"[MeSH Terms] OR
ultrasound*[Title/Abstract] OR ultrasonograph*[Title/Abstract] OR ultra sound*[Title/Abstract] OR
Embase
1 exp epidural anesthesia/ or exp epidural analgesia/ or exp epidural drug administration/ or ((epidural* or peridural*
or extradural* or subarachnoid* or intrathecal* or neuraxial*) and (catheter* or cannula*)).mp. [mp=title, abstract,
heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword,
floating subheading] (51059)
3 1 and 2 (1753)
5 3 not 4 (1735)
Central
#1 MeSH descriptor: [Anesthesia, Epidural] explode all trees 1932

#2 MeSH descriptor: [Analgesia, Epidural] explode all trees 1930
#3 MeSH descriptor: [Injections, Epidural] explode all trees 492
#4 (epidural* or peridural* or extradural* or subarachnoid* or intrathecal* or neuraxial*) and (catheter* or
ca*nula*) 2128
#5 #1 or #2 or #3 or #4 5385
#8 #6 or #7 27596
#9 #5 and #8 236
Cinahl
(MH "Epidural Catheters") OR (MH "Infusions, Epidural") OR (MH "Analgesia, Epidural") OR (MH
"Anesthesia, Epidural") OR TX (epidural* or peridural* or extradural* or subarachnoid* or
S1 intrathecal* or neuraxial*) 11,320

S3 S1 AND S2 366
S5 S3 not S4 359

PICO 25
Epidural anaesthesia
Population/problem
Patients requiring siting of Spinal anaesthesia
Intervention
Ultrasound-guided epidural
Comparators
Any other technique of epidural catheter insertion
Outcomes
Adequacy of epidural analgesia
Time to perform epidural
Nerve damage
Vascular puncture
Dural puncture
Epidural haematoma
Post-procedural back pain
Search date: 8 march 2017
PubMed
"Anesthesia, Spinal"[Mesh] OR "Infusions, Spinal"[Mesh] OR "Injections, Spinal"[Mesh] OR (spinal*[Text Word] AND

(anaesth*[Text Word] OR anesth*[Text Word] OR analg*[Text Word] OR infusion*[Text Word] OR injection*[Text Word]
OR catheter*[Text Word] OR cannula*[Text Word]))
AND
Search (((("Anesthesia, Spinal"[Mesh] OR "Infusions, Spinal"[Mesh] OR "Injections, Spinal"[Mesh] OR (spinal*[Text 830

Word] AND (anaesth*[Text Word] OR anesth*[Text Word] OR analg*[Text Word] OR infusion*[Text Word] OR
injection*[Text Word] OR catheter*[Text Word] OR cannula*[Text Word]))))) AND ("ultrasonography"[MeSH Terms]
OR ultrasound*[Title/Abstract] OR ultrasonograph*[Title/Abstract] OR ultra sound*[Title/Abstract] OR
Embase
1 spinal anesthesia/ or exp intraspinal drug administration/ or (spinal and (an?esth* or analg* or infusion* or injection*
or catheter* or cannula*)).ti,ab. (96102)
3 1 and 2 (2422)
5 3 not 4 (2364)
Central
#1 MeSH descriptor: [Infusions, Spinal] explode all trees 9

#2 MeSH descriptor: [Anesthesia, Spinal] explode all trees 2152
#3 MeSH descriptor: [Injections, Spinal] explode all trees 1472
#4 (spinal and (an*esth* or analg* or infusion* or injection* or catheter* or can*ula*)) 9371
#5 #1 or #2 or #3 or #4 9715
#8 #6 or #7 27596
#9 #5 and #8 540
Cinahl
(MH "Anesthesia, Spinal") OR TX (spinal and (an*esth* or analg* or infusion* or injection* or

S1 catheter* or cannula*)) 26,557

S3 S1 AND S2 625
S5 S3 not S4 615

Appendix 2. Number of abstracts screened and included per cluster
CLUSTER Abstract found Number of screened Number of excluded

studies studies
PICO 13 interscalene 579 20 10
brachial plexus block
PICO 14 supraclavicular 450 15 6
PICO 15 infraclavicular 291 22 8
PICO 16 axillary 526 31 13
PICO 20 femoral nerve 771 18 12
block
PICO 18 sciatic 122 99 4
subgluteal block
PICO 21 popliteal block 365 14 11
PICO 19 Truncal blocks 2611 93 91
PICO 23 Paravertebral 408 13 2
blocks
PICO 24 Prelocation for 1622 6 5
epidural analgesia
PICO 25 Prelocation for 2478 35 8
spinal anaesthesia
Appendix 3: Grades of recommendation – Grading of Recommendations Assessment, Development
and Evaluation System
Grade of Recommendation Clarity of Quality of supporting evidence Implications

risk/benefit
1A. Benefits clearly Consistent evidence from well performed Strong recommendations, can apply to most
outweigh risk and randomized, controlled trials or overwhelming patients in most circumstances without
Strong recommendation, high burdens, or vice evidence of some other form. Further research reservation. Clinicians should follow a strong
quality evidence versa. is unlikely to change our confidence in the recommendation unless a clear and
estimate of benefit and risk. compelling rationale for an alternative
approach is present.
1B. Benefits clearly Evidence from randomized, controlled trials Strong recommendation and applies to most
outweigh risk and with important limitations (inconsistent results, patients. Clinicians should follow a strong
Strong recommendation, burdens, or vice methodologic flaws, indirect or imprecise), or recommendation unless a clear and
moderate quality evidence versa. very strong evidence of some other research compelling rationale for an alternative
design. Further research (if performed) is likely approach is present.
to have an impact on our confidence in the
estimate of benefit and risk and may change the
estimate.
1C. Benefits appear to Evidence from observational studies, Strong recommendation, and applies to most
outweigh risk and unsystematic clinical experience, or from patients. Some of the evidence base
Strong recommendation, low burdens, or vice randomized, controlled trials with serious flaws. supporting the recommendation is, however,
quality evidence versa. Any estimate of effect is uncertain. of low quality.
2A. Benefits closely Consistent evidence from well performed Weak recommendation, best action may
balanced with randomized, controlled trials or overwhelming differ depending on circumstances or patients
Weak recommendation, high risks and burdens. evidence of some other form. Further research or societal values.
quality evidence is unlikely to change our confidence in the
estimate of benefit and risk.
2B. Benefits closely Evidence from randomized, controlled trials Weak recommendation, alternative
balanced with with important limitations (inconsistent results, approaches likely to be better for some
Weak recommendation, risks and burdens, methodologic flaws, indirect or imprecise), or patients under some circumstances.
moderate quality evidence some uncertainly very strong evidence of some other research
in the estimates of design. Further research (if performed) is likely
benefits, risks and to have an impact on our confidence in the
burdens. estimate of benefit and risk and may change the
estimate.
2C. Uncertainty in the Evidence from observational studies, Very weak recommendation; other
estimates of unsystematic clinical experience, or from alternatives may be equally reasonable.
Weak recommendation, low benefits, risks, and randomized, controlled trials with serious flaws.
quality evidence burdens; benefits Any estimate of effect is uncertain.
may be closely
balanced with
risks and burdens.
Appendix 4.
Forrest plots of the main results from the Revman analysis.
5.1. Upper limb blocks
5.1.1 Interscalene brachial plexus block

5.1.1.1. Adequacy of anaesthesia for intended surgery
5.1.1.2. Adequacy of postoperative analgesia
5.1.1.3. Time to perform and achieve block

5.1.1.5. Incidence of complications
5.1.1.7. Patient satisfaction with the procedure

5.1.2 Supraclavicular block
5.1.2.3. Time to perform block
5.1.2.4. Time to achieve effective block

5.1.3 Infraclavicular nerve block
5.1.3.2. Adequacy of postoperative analgesia

5.1.3.7. Patient discomfort during procedure

5.1.4 Axillary brachial plexus block

5.1.4.7. Patient discomfort or pain during procedure

5.2 Lower limb blocks

5.2.1 Femoral nerve or fascia iliaca block
5.2.1.2. Adequacy of postoperative analgesia: requirement for morphine at 48hrs
5.2.1.2. Adequacy of postoperative analgesia: VAS postop at mobilization 48hrs after

surgery

5.2.3 Subgluteal popliteal sciatic nerve block



5.2.3.9. Needle passes
5.3. Abdominal and thoracic truncal blocks
5.3.1.1. Quality of analgesia: PACU morphine consumption (TAP block)
5.3.1.1. Quality of analgesia: PACU morphine consumption (rectus sheath block)

5.3.1.1. Quality of analgesia:24hrs morphine consumption (TAP block)
5.3.1.1. Quality of analgesia:24hrs morphine consumption (IHII)
5.3.1.1. Quality of analgesia:24hrs morphine consumption (rectus sheath block)
5.3.1.1. Quality of analgesia:24hrs morphine consumption (serratus anterior block)

5.3.1.1. Quality of analgesia: NRS in PACU (TAP block)
5.3.1.1. Quality of analgesia: NRS in PACU (IHII)
5.3.1.1. Quality of analgesia: NRS at 24hrs (TAP block)
5.3.1.1. Quality of analgesia: NRS at 24hrs (IHII)
5.3.1.2. Incidence of complications (TAP block)

5.3.1.2. Incidence of complications (IHII)
5.3.1.2. Incidence of complications (rectus sheath block)

5.3.1.2. Incidence of complications: PONV (TAP block)
5.3.1.2. Incidence of complications: PONV (IHII)

5.3.1.2. Incidence of complications: PONV (serratus anterior block)
5.3.1.2. Incidence of complications: urinary retention (TAP block)
5.3.1.2. Incidence of complications: urinary retention (IHII)

5.3.1.2. Time to postoperative mobilization (TAP block)
5.3.1.2. Time to postoperative mobilization (IHII)
5.3.1.3. Time in PACU (TAP block)
5.3.1.3. Time in PACU (IHII)

5.3.1.5. Time to discharge (TAP block)
5.3.1.6. Patient satisfaction (TAP block)
5.3.1.6. Patient satisfaction (TAP block: sub-analysis on NRS)

5.3.1.6. Patient satisfaction (IHII)
5.4 Neuraxial anaesthesia
5.4.1 Paravertebral blocks


5.4.3 Epidural analgesia
5.4.3.1. Adequacy of epidural anaesthesia
5.4.3.2. Time to perform epidural anaesthesia
5.4.4. Incidence of complications

5.4.8. Postprocedural back pain
5.5 Spinal anaesthesia

5.4.10.2. Time to perform spinal anaesthesia excluding scanning time

5.4.10.2. Time to perform spinal anaesthesia including scanning time
5.4.10.4. Patient satisfaction: patients satisfied and very satisfied

Appendix 5.
Recommendations for training arising from the PERSEUS Delphi Consensus process
Statement Median DI
score
Section 1 - Generic learning/training objectives
At the completion of their training the practitioner should be able to demonstrate:
Knowledge of what ultrasound is and how it is generated 9 0.132
An understanding of the relationship between frequency used, image quality and tissue 9 0
penetration
Knowledge of the biological effects and safety of ultrasound 8 0.137
An understanding of the basic principles of real time and Doppler ultrasound including colour 8 0.137
flow and power Doppler
Selection of the most appropriate transducer for different examinations 9 0
Adjustment of ultrasound machine settings to optimise Image quality 9 0
Adjustment of transducer pressure, alignment, rotation and tilting to optimise Image quality 9 0
Identification of arteries, veins, nerves, tendons, muscle and fascia, bones and air-filled spaces 9 0
Recognition of common artefacts and provide an explanation of how they occur 9 0
An understanding of in-plane and out-of-plane needle visualisation techniques 9 0
Knowledge of the benefits and limitations of in-plane and out-of-plane techniques 9 0
The capability to minimise unintended transducer movement during needle visualisation 9 0
The capability to maintain visualisation of the needle shaft and tip during in-plane techniques 9 0
The capability to visualise the needle tip during out-of-plane techniques 9 0
That they can record ultrasound images 9 0.292
An understanding of the principles of patient information, consent and preparation for 9 0.046
ultrasound guided procedure
Understanding the importance of practising within their own level of competence 9 0
Procedures to minimise the risks of incorrect-site interventions 9 0
Procedures to minimise cross-infection from ultrasound equipment 9 0
The capability to perform ultrasound guided procedures under sterile condition 9 0
An understanding of the value and techniques of continual personal audit for quality assurance 9 0.046
and improvement
Section 2 - Learning & assessment methods for generic competencies

Learning and assessment methods should be tailored to learning objectives 9 0
Certificating organisations should decide learning and assessment methods for each learning 8 0.187
objective
Training course organisers should be able to request approval for proposed learning and 8 0.299
assessment methods from the ESA or relevant national societies.
Training and successful assessment in a teaching laboratory simulation environment is essential 9 0.187
before the practitioner undertakes US guided procedures on patients
Assessment of competence to perform practical procedures is best undertaken using a global 9 0.132
rating score added to a checklist of the individual components of the task
Before attempting their first directly supervised ultrasound guided intervention the practitioner 7.5 0.292
should have observed 5 ultrasound guided procedures and performed 5 ultrasound scans on
patients scheduled for ultrasound guided procedures
Section 3 - Specific learning/training objectives for US guided vascular access.

At the completion of their training the practitioner, in addition to achieving the generic objectives, should be able to
demonstrate:
Knowledge of the sectional and ultrasonic anatomy of the neck, axillary/subclavian veins, arm 9 0
(basilic vein), groin/femoral triangle, forearm (radial artery)
That they can recognise vascular pathology using ultrasound e.g. vessel patency, occlusion, deep 7.5 0.200
venous thrombosis, arterial thrombosis, pseudo aneurysm, arteriovenous fistula
Capability to use techniques to augment the size of different veins 9 0
Proper selection of the catheter/vein ratio 9 0
Identification of the intravascular location of guide wire and catheter tip 9 0
Techniques for catheter tip navigation 9 0.132
Pleural and lung ultrasound techniques for ruling out complications of central venous access 8.5 0.187
Section 4 - Training & assessment methods for US guided vascular access

Before attempting their first directly supervised attempt for each ultrasound guided vascular 9 0.132
access procedure the practitioner should have observed 5 ultrasound guided procedures of that
type and performed 5 ultrasound scans on patients scheduled for that ultrasound guided
procedure
The practitioner undergoing training in US guided vascular access should maintain a logbook 8 0.200
that documents every procedure they perform
For each ultrasound guided vascular access procedure the practitioner should be directly 9 0.187
observed for at least 5 ultrasound guided procedures of that type before they perform the
procedure unsupervised.
For each ultrasound guided vascular access procedure the practitioner should be signed off as 8.5 0.187
competent for that procedure by an expert trainer using a global rating scale before they
perform the procedure unsupervised.
To be eligible for completion of competency-based training in paediatric US guided vascular 7.5 0.467
access the practitioner should have performed 30 US guided vascular access procedures of any
type in a 12 month period
To be eligible for completion of competency-based training in US guided vascular access 9 0.046
cumulative summated outcomes for key performance indicators should be within the tolerance
limits of expert practice standards.
Competence in US guided vascular access for eligible practitioners will be signed off if they 8 0.187
achieve satisfactory global rating scores following direct observation of a procedure by an
expert trainer
Maintenance of competence in US guided vascular access will require cumulative summated 8 0.292
outcomes for key performance indicators to be within the tolerance limits of expert practice
standards
Maintenance of competence in US guided vascular access will require evidence of regular 8 0.137
continuing professional development activities relevant to US guided vascular access
Maintenance of competence in US guided vascular access should be based on performance 9 0.132
indicators only and not number of procedures
Section 5 - Performance indicators for US guided vascular access procedures.

The following are useful performance indicators for US guided vascular access:
First-time puncture rate 8.5 0.132
Successful completion of procedure within 30 minute 8 0.164
Total procedural time 7.5 0.271
Incidence of major complications 9 0
Incidence of all complication 9 0.046
Patient satisfaction 8 0.29
Section 6 - Criteria for defining an expert trainer in US guided vascular access.

An expert trainer in US guided vascular access must be able to demonstrate
One year of independent practice in US guided vascular access following completion of 8 0.361
competency-based training, or
Continuous independent practice in US guided vascular access for at least 3 years and which 9 0.137
began before the introduction of competency-based training ("Grandfather" clause)
Cumulative summated outcomes for key performance indicators to be within the tolerance 8.5 0.187
limits of expert practice standards
Evidence of regular continuing professional development activities relevant to US guided 8 0.093
vascular access and education/training
For paediatric practice, should meet relevant national criteria for maintaining practice privileges 8 0.132
as specialist paediatric anaesthesiologist in children from the relevant age group (neonate,
infant, toddler, older child)
Section 7 - Specific learning/training objectives for US guided regional anaesthesia.

At the completion of their training the practitioner, in addition to achieving the generic objectives, should be able to
demonstrate:
Knowledge of the sectional and ultrasonic anatomy of the brachial plexus and its branches, 9 0
sciatic nerve & its branches, femoral nerve and its branches, vertebral column and epidural
space, paravertebral space, anatomy relevant to truncal blocks
That they can recognise relevant variant anatomy using ultrasound e.g. anatomical relations of 9 0.089
nerves, branching of nerves, abnormal nerve morphology, perineuronal blood vessels
Supplementary techniques to confirm needle tip location 9 0
Knowledge of perineural catheter techniques 9 0.089
Section 8 - Training & assessment methods for US guided regional anaesthesia

Before attempting their first directly supervised attempt for each ultrasound guided regional 9 0.132
anaesthesia procedure the practitioner should have observed 5 ultrasound guided procedures
of that type and performed 5 ultrasound scans on patients scheduled for that ultrasound guided
procedure.
The practitioner undergoing training in US guided regional anaesthesia should maintain a 9 0.132
logbook that documents every procedure they perform
For each ultrasound guided regional anaesthesia procedure the practitioner should be directly 9 0.132
observed for at least 5 ultrasound guided procedures of that type before they perform the
procedure unsupervised.
For each ultrasound guided regional anaesthesia procedure the practitioner should be signed off 9 0.132
as competent for that procedure by an expert trainer using a global rating scale before they
perform the procedure unsupervised.
To be eligible for completion of competency-based training in US guided regional anaesthesia 8 0.48
the practitioner should have performed 50 US guided regional anaesthesia procedures of any
type in a 12 month period
To be eligible for completion of competency-based training in US guided regional anaesthesia 8 0.132
cumulative summated outcomes for key performance indicators should be within the tolerance
limits of expert practice standards.
Competence in US guided regional anaesthesia for eligible practitioners will be signed off by 8 0.132
satisfactory global rating scores following direct observation of a procedure by an expert trainer.
Maintenance of competence in US guided regional anaesthesia will require cumulative 8 0.132
summated outcomes for key performance indicators to be within the tolerance limits of expert
practice standards
Maintenance of competence in US guided regional anaesthesia will require evidence of regular 8 0.164
continuing professional development activities relevant to US guided regional anaesthesia
Maintenance of competence in US guided regional anaesthesia should be based on 8 0.122
performance indicators only and not number of procedures
Section 9 - Performance indicators for US guided regional anaesthesia procedures.

The following are useful performance indicators for US guided regional anaesthesia:
Successful block rate (no supplementation) 8 0.132
Rate of conversion to unplanned general anaesthesia 8.5 0.132
Completion of procedure within 30 minutes 8 0.187
Total procedural time 8 0.292
Incidence of major complications 9 0
Incidence of all complications 9 0
Patient satisfaction 8 0.187
Section 10 - Criteria for defining an expert trainer in US guided regional anaesthesia.

An expert trainer in US guided regional anaesthesia must be able to demonstrate:
One year of independent practice in US guided regional anaesthesia following completion of 8 0.129
competency-based training, or
Continuous independent practice in US guided regional anaesthesia for at least 5 years and 7.5 0.499
which began before the introduction of competency-based training
Cumulative summated outcomes for key performance indicators to be within the tolerance 9 0.132
limits of expert practice standards
Evidence of regular continuing professional development activities relevant to US guided 8 0.290
regional anaesthesia and education/training
Completion of 50 US guided regional anaesthesia procedures per year 9 0.132
Legend: MAS 7-9: appropriate DI <1 indicates consensus

02 PERSEUS USGRA Appendices

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02 PERSEUS USGRA Appendices

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Appendix 1.

Search date: 6. March 2017

S4 (MH "Ultrasonography+") 35,830

S5 TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph* AND an*esth*)) 47,050

S8 (MH "Animals+") not (MH "Human") 31,176

S10 S7 not S8 Published: 20050101-20171231 48

Search date: 6. march 2017

S4 (MH "Ultrasonography+") 35,830

S5 TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph* AND an*esth*)) 47,050

S8 (MH "Animals+") not (MH "Human") 31,176

Search date: 7. March 2017

S4 (MH "Ultrasonography+") 35,830

S5 TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph* AND an*esth*)) 47,050

S8 (MH "Animals+") not (MH "Human") 31,176

Search date: 7. March 2017

S4 (MH "Ultrasonography+") 35,843

S5 TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph* AND an*esth*)) 47,059

S8 (MH "Animals+") not (MH "Human") 31,182

S10 S7 not S8 Published: 20050101-20171231 42

Search date: 7. March 2017

Sciatic*[Text Word] OR "Sciatic Nerve"[Mesh]

S1 (MH "Sciatic Nerve+") or TX (sciatic*) 2,700

(MM ”Anesthesia, Local“) OR (MM ”Nerve Block“) OR TX (block* or ((local* OR regional*) N5

(MH "Ultrasonography+") or TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph*

S4 S1 AND S2 AND S3 116

S5 (MH "Animals+") not (MH "Human") 31,182

S7 S4 not S5 Published: 20050101-20171231 108

Search date: 9. March 2017

Trunk*[Title/Abstract] OR torso*[Title/Abstract] OR abdom*[Title/Abstract] OR pelvis*[Title/Abstract] OR

Search (((((Trunk*[Title/Abstract] OR torso*[Title/Abstract] OR abdom*[Title/Abstract] OR pelvis*[Title/Abstract] 1019

(MM ”Anesthesia, Local“) OR (MM ”Nerve Block“) OR TX (block* OR ((local* OR regional*) N5

(MH "Ultrasonography+") OR TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph*

S4 S1 AND S2 AND S3 182

S7 S4 not S5 Published: 20050101-20171231 141

Search date: 7. March 2017

(femoral*[Text Word] AND nerve*[Text Word]) OR "Femoral Nerve"[Mesh]

#1 femoral* near/5 Nerve* 773

S1 (MH "Femoral Nerve") or TX (femoral* N5 nerve*) 644

(MM ”Anesthesia, Local“) OR (MM ”Nerve Block“) OR TX (block* or ((local* OR regional*) N5

(MH "Ultrasonography+") or TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph*

S5 (MH "Animals+") not (MH "Human") 31,182

S7 S4 not S5 Published: 20050101-20171231 78

Search date: 7. March 2017

"Popliteal Vein"[Mesh] OR "Popliteal Artery"[Mesh] OR Popliteal*[Text Word]

#1 MeSH descriptor: [Popliteal Artery] explode all trees 335

S1 (MH "Popliteal Vein") OR (MH "Popliteal Artery") or TX Popliteal* 838

(MM ”Anesthesia, Local“) OR (MM ”Nerve Block“) OR TX (block* or ((local* OR regional*) N5

(MH "Ultrasonography+") or TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR

S5 (MH "Animals+") not (MH "Human") 31,182

S7 S4 not S5 Published: 20050101-20171231 37

Search date: 8 march 2017

Search (((paravertebral*) AND (("Anesthesia, Local"[Mesh]) OR "Nerve Block"[Mesh] OR block*[Title/Abstract] OR 157

(MM ”Anesthesia, Local“) OR (MM ”Nerve Block“) OR TX (block* or ((local* OR regional*) N5

(MH "Ultrasonography+") or TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph*

S5 (MH "Animals+") not (MH "Human") 31,182

S7 s4 not s5 Published: 20050101-20171231 24

Search date: 8. march 2017

"Analgesia, Epidural"[Mesh] OR "Injections, Epidural"[Mesh] OR "Anesthesia, Epidural"[Mesh] OR

Search (((("Analgesia, Epidural"[Mesh] OR "Injections, Epidural"[Mesh] OR "Anesthesia, Epidural"[Mesh] OR 452

#1 MeSH descriptor: [Anesthesia, Epidural] explode all trees 1932

(MH "Ultrasonography+") or TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph*

S4 (MH "Animals+") not (MH "Human") 31,182

S6 S3 not S4 Published: 20050101-20171231 273

Search date: 8 march 2017

S5 TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph* AND anesth)) 47,050

S5 TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph* AND anesth)) 47,050

S5 TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph* AND anesth)) 47,050

S5 TX (Ultrasound* OR ultra sound* OR ultrasonograph* OR (echograph* AND anesth)) 47,059

Trunk[Title/Abstract] OR torso[Title/Abstract] OR abdom[Title/Abstract] OR pelvis[Title/Abstract] OR

Search (((((Trunk[Title/Abstract] OR torso[Title/Abstract] OR abdom[Title/Abstract] OR pelvis[Title/Abstract] 1019

(femoral[Text Word] AND nerve[Text Word]) OR "Femoral Nerve"[Mesh]

Search (((paravertebral) AND (("Anesthesia, Local"[Mesh]) OR "Nerve Block"[Mesh] OR block[Title/Abstract] OR 157

(MH "Anesthesia, Spinal") OR TX (spinal and (anesth or analg* or infusion* or injection* or