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class="bkr_bib"><h1 id="_NBK561389_"><span itemprop="name">Evidence review for anaesthesia for shoulder replacement</span></h1><div class="subtitle">Joint replacement (primary): hip, knee and shoulder</div><p><b>Evidence review F</b></p><p><i>NICE Guideline, No. 157</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2020 Jun</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3722-6</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2020.</div></div><div class="bkr_clear"></div></div><div id="niceng157er6.s1"><h2 id="_niceng157er6_s1_">1. Anaesthesia for elective shoulder joint replacement</h2><div id="niceng157er6.s1.1"><h3>1.1. Review question: In adults having primary elective shoulder joint replacement, what is the most clinical and cost effective intraoperative anaesthetic approach?</h3></div><div id="niceng157er6.s1.2"><h3>1.2. Introduction</h3><p>Elective primary shoulder replacement surgery is most commonly performed under a general anaesthetic. In recent years pain control post-surgery for patients has changed greatly. Pain control is important to aid recovery and additional options are discussed with patients pre-operatively and choices made about supplementary pain blocking procedures and post-operative analgesia (pain killers).</p><p>In addition to general anaesthesia, anaesthetists as routine now offer supplementary local anaesthetic interventions. Firstly a nerve block is an injection of anaesthetic into the nerves that supply the shoulder joint. The second option is local anaesthetic infiltration where a large volume of anaesthetic is injected it into the tissues around the operation site.</p><p>It is considered that such adjunct pre-emptive analgesic methods allow shoulder replacement patients to wake up pain free and get up and out of bed almost immediately post-operatively which can aid earlier discharge from hospital and less peri-operative morbidity.</p><p>Regional anaesthesia via inter-scalene nerve blocks under ultrasound guidance is now common practice in orthopaedic shoulder units for patients undergoing such surgery if there is no contraindication. These can be utilised instead or on top of general anaesthesia and do not benefit from augmentation with other nerve blocks or local anaesthetic infiltration.</p><p>This review seeks to determine the most clinically effective and cost-effective approach to anaesthesia for total shoulder replacement surgery.</p></div><div id="niceng157er6.s1.3"><h3>1.3. PICO table</h3><p>For full details see the review protocol in <a href="#niceng157er6.appa">Appendix A</a>:</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng157er6tab1"><a href="/books/NBK561389/table/niceng157er6.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng157er6tab1" rid-ob="figobniceng157er6tab1"><img class="small-thumb" src="/books/NBK561389/table/niceng157er6.tab1/?report=thumb" src-large="/books/NBK561389/table/niceng157er6.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="niceng157er6.tab1"><a href="/books/NBK561389/table/niceng157er6.tab1/?report=objectonly" target="object" rid-ob="figobniceng157er6tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="niceng157er6.s1.4"><h3>1.4. Clinical evidence</h3><div id="niceng157er6.s1.4.1"><h4>1.4.1. Included studies</h4><p>A search was conducted for trials comparing the effectiveness of intraoperative anaesthesia and analgesia routines utilised for primary shoulder joint replacement surgery.</p><p>Five studies were included in the review;<a class="bibr" href="#niceng157er6.ref10" rid="niceng157er6.ref10"><sup>10</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng157er6.ref18" rid="niceng157er6.ref18"><sup>18</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng157er6.ref61" rid="niceng157er6.ref61"><sup>61</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng157er6.ref66" rid="niceng157er6.ref66"><sup>66</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng157er6.ref81" rid="niceng157er6.ref81"><sup>81</sup></a> these are summarised in <a class="figpopup" href="/books/NBK561389/table/niceng157er6.tab2/?report=objectonly" target="object" rid-figpopup="figniceng157er6tab2" rid-ob="figobniceng157er6tab2">Table 2</a> below. Evidence from these studies is summarised in the clinical evidence summary below (<a class="figpopup" href="/books/NBK561389/table/niceng157er6.tab3/?report=objectonly" target="object" rid-figpopup="figniceng157er6tab3" rid-ob="figobniceng157er6tab3">Table 3</a>, <a class="figpopup" href="/books/NBK561389/table/niceng157er6.tab4/?report=objectonly" target="object" rid-figpopup="figniceng157er6tab4" rid-ob="figobniceng157er6tab4">Table 4</a> and <a class="figpopup" href="/books/NBK561389/table/niceng157er6.tab5/?report=objectonly" target="object" rid-figpopup="figniceng157er6tab5" rid-ob="figobniceng157er6tab5">Table 5</a>).</p></div><div id="niceng157er6.s1.4.2"><h4>1.4.2. Excluded studies</h4><p>See the excluded studies list in <a href="#niceng157er6.appi">Appendix I</a>:</p></div><div id="niceng157er6.s1.4.3"><h4>1.4.3. Summary of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng157er6tab2"><a href="/books/NBK561389/table/niceng157er6.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng157er6tab2" rid-ob="figobniceng157er6tab2"><img class="small-thumb" src="/books/NBK561389/table/niceng157er6.tab2/?report=thumb" src-large="/books/NBK561389/table/niceng157er6.tab2/?report=previmg" alt="Table 2. Summary of studies included in the evidence review." /></a><div class="icnblk_cntnt"><h4 id="niceng157er6.tab2"><a href="/books/NBK561389/table/niceng157er6.tab2/?report=objectonly" target="object" rid-ob="figobniceng157er6tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review. </p></div></div><p>See <a href="#niceng157er6.appd">Appendix D</a>: for full evidence tables.</p></div><div id="niceng157er6.s1.4.4"><h4>1.4.4. Quality assessment of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng157er6tab3"><a href="/books/NBK561389/table/niceng157er6.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figniceng157er6tab3" rid-ob="figobniceng157er6tab3"><img class="small-thumb" src="/books/NBK561389/table/niceng157er6.tab3/?report=thumb" src-large="/books/NBK561389/table/niceng157er6.tab3/?report=previmg" alt="Table 3. RCT evidence summary: General anaesthesia with LIA versus general anaesthesia with regional anaesthesia." /></a><div class="icnblk_cntnt"><h4 id="niceng157er6.tab3"><a href="/books/NBK561389/table/niceng157er6.tab3/?report=objectonly" target="object" rid-ob="figobniceng157er6tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">RCT evidence summary: General anaesthesia with LIA versus general anaesthesia with regional anaesthesia. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng157er6tab4"><a href="/books/NBK561389/table/niceng157er6.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figniceng157er6tab4" rid-ob="figobniceng157er6tab4"><img class="small-thumb" src="/books/NBK561389/table/niceng157er6.tab4/?report=thumb" src-large="/books/NBK561389/table/niceng157er6.tab4/?report=previmg" alt="Table 4. Non-randomised evidence summary: Regional anaesthesia versus general anaesthesia with or without regional blockade." /></a><div class="icnblk_cntnt"><h4 id="niceng157er6.tab4"><a href="/books/NBK561389/table/niceng157er6.tab4/?report=objectonly" target="object" rid-ob="figobniceng157er6tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Non-randomised evidence summary: Regional anaesthesia versus general anaesthesia with or without regional blockade. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng157er6tab5"><a href="/books/NBK561389/table/niceng157er6.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figniceng157er6tab5" rid-ob="figobniceng157er6tab5"><img class="small-thumb" src="/books/NBK561389/table/niceng157er6.tab5/?report=thumb" src-large="/books/NBK561389/table/niceng157er6.tab5/?report=previmg" alt="Table 5. Non-randomised evidence summary: General anaesthesia with peripheral nerve block versus general anaesthesia." /></a><div class="icnblk_cntnt"><h4 id="niceng157er6.tab5"><a href="/books/NBK561389/table/niceng157er6.tab5/?report=objectonly" target="object" rid-ob="figobniceng157er6tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Non-randomised evidence summary: General anaesthesia with peripheral nerve block versus general anaesthesia. </p></div></div><p>See <a href="#niceng157er6.appf">Appendix F</a>: for full GRADE tables.</p></div></div><div id="niceng157er6.s1.5"><h3>1.5. Economic evidence</h3><div id="niceng157er6.s1.5.1"><h4>1.5.1. Included studies</h4><p>No relevant health economic studies were identified in the literature search, however, one original threshold analysis was conducted which can be found in <a href="#niceng157er6.appi">Appendix I: Nerve block threshold analysis</a></p></div><div id="niceng157er6.s1.5.2"><h4>1.5.2. Excluded studies</h4><p>One health economic study <a class="bibr" href="#niceng157er6.ref33" rid="niceng157er6.ref33"><sup>33</sup></a> was excluded due to assessment of methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#niceng157er6.appg">Appendix G</a>:</p></div><div id="niceng157er6.s1.5.3"><h4>1.5.3. Summary of studies included in the economic evidence review</h4><p>No studies were included</p></div><div id="niceng157er6.s1.5.4"><h4>1.5.4. Health economic modelling</h4><p>A threshold analysis was conducted on the addition of nerve blocks to an anaesthetic regimen. This was conducted as the committee agreed that nerve blocks are likely to be a costly intervention. LIA, on the other hand, is a much cheaper intervention. No economic evidence was found for either intervention.</p><p>The method and results of the analysis can be found in <a href="#niceng157er6.appi">Appendix I: Nerve block threshold analysis</a>. The analysis uses estimates of incremental cost to find what QALY or utility gain is required at a given threshold of cost effectiveness. The threshold selected for this analysis was £20,000 in line with the NICE reference case. A range of incremental costs driven by the time required to administer the nerve block (30 minutes, 10 minutes and 5 minutes) and if the cost of theatre time was incorporated (yes or no) were included in the analysis. The rationale for having theatre time included as a cost variable is that the committee suggested that if 2 anaesthetists are available a nerve block can be administered in the anaesthesia room, not incurring additional theatre time costs. Therefore, for scenarios where theatre time was not included, 2 consultant anaesthetists were costed in. Whereas when theatre time was included, only one consultant anaesthetist was costed in. The results found that a nerve block is unlikely to be cost effective the longer it takes to administer, the shorter the effect duration, and if theatre time cost is included. However there are circumstances, such as when administration time is short, effect duration is long and theatre time is not included, when a nerve block could be cost effective. The different combinations of these factors are present across the NHS, so nerve blocks may be a viable cost-effective anaesthetic intervention for some hospitals but not for others.</p></div><div id="niceng157er6.s1.5.5"><h4>1.5.5. Unit costs</h4><p>Relevant unit costs for the addition of a nerve block to an anaesthetic regimen are provided</p><p><a class="figpopup" href="/books/NBK561389/table/niceng157er6.tab6/?report=objectonly" target="object" rid-figpopup="figniceng157er6tab6" rid-ob="figobniceng157er6tab6">Table 6</a> to aid consideration of cost effectiveness. A cost utility analysis from 2015 that looked at the cost effectiveness of anaesthetic regimens in a hip and knee replacement population <a class="bibr" href="#niceng157er6.ref57" rid="niceng157er6.ref57"><sup>57</sup></a> stated that an injection of LIA costed £2.00 per unit.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng157er6tab6"><a href="/books/NBK561389/table/niceng157er6.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figniceng157er6tab6" rid-ob="figobniceng157er6tab6"><img class="small-thumb" src="/books/NBK561389/table/niceng157er6.tab6/?report=thumb" src-large="/books/NBK561389/table/niceng157er6.tab6/?report=previmg" alt="Table 6. UK 2018 cost for the addition of a nerve block to an anaesthetic regimen for primary elective joint replacement when varying administration time and the inclusion of theatre time cost." /></a><div class="icnblk_cntnt"><h4 id="niceng157er6.tab6"><a href="/books/NBK561389/table/niceng157er6.tab6/?report=objectonly" target="object" rid-ob="figobniceng157er6tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">UK 2018 cost for the addition of a nerve block to an anaesthetic regimen for primary elective joint replacement when varying administration time and the inclusion of theatre time cost. </p></div></div></div></div><div id="niceng157er6.s1.6"><h3>1.6. Evidence statements</h3><div id="niceng157er6.s1.6.1"><h4>1.6.1. Clinical evidence statements</h4><p>3 RCTs (n=282) comparing general anaesthesia with LIA to general anaesthesia with regional anaesthesia found a benefit for general anaesthesia with regional anaesthesia in postoperative pain and postoperative use of analgesia. General anaesthesia with LIA was better in phrenic nerve palsy. There was no difference between interventions in thromboembolic complications and 2 length of stay outcomes. Nearly all outcomes were deemed to be of very low quality though 1 length of stay outcome was moderate quality.</p><p>1 non-randomised study (n=4158) reported on regional anaesthesia versus general anaesthesia with or without regional blockade. This was a retrospectively propensity-matched sample of 1824 people and it found a benefit for regional anaesthesia in readmission. There was a benefit for general anaesthesia with or without regional blockade in thromboembolic complications. No difference was seen between interventions in length of stay or gastrointestinal complications. All outcomes were graded very low quality.</p><p>1 non-randomised study (n=17,157) reported on General anaesthesia with peripheral nerve block versus general anaesthesia. This was a sample of 17157 people with multivariate analysis. All outcomes indicated no difference between interventions; these were intensive care unit admission, pulmonary complications, and length of stay. All outcomes were graded very low quality.</p></div><div id="niceng157er6.s1.6.2"><h4>1.6.2. Health economic evidence statements</h4><p>One original threshold analysis for the addition of a nerve block to any anaesthetic regimen found that nerve blocks are unlikely to be cost effective if theatre time is included in the incremental cost or if administration time is longer. However, it is possible the addition of a nerve block is cost effective if administration time is short, the cost of theatre time is not included and if the duration of effect used in the analysis is longer. The cost of theatre time can be excluded when there are two anaesthetists present so that the nerve block can be administered in the anaesthesia room, therefore not taking up extra theatre time.</p></div></div><div id="niceng157er6.s1.7"><h3>1.7. The committee’s discussion of the evidence</h3><div id="niceng157er6.s1.7.1"><h4>1.7.1. Interpreting the evidence</h4><div id="niceng157er6.s1.7.1.1"><h5>1.7.1.1. The outcomes that matter most</h5><p>The critical outcomes are mortality, quality of life, postoperative pain, postoperative neurocognitive decline, thromboembolic complications, hospital readmission, phrenic nerve injury, and brachial plexus injury. The time point for mortality, the most critical outcome, was specified to within 90 days because the committee were concerned that there are confounding factors that will not be adequately resolved over longer time periods. There are many factors outside of anaesthetic used during joint replacement surgery that contribute towards mortality and these expand as a person moves further on in their life. The committee were aware the trials would not be of an adequate size to equalise these factors between treatment groups. Postoperative pain is of critical importance as it represents a central aspect of a person’s initial experience of the joint replacement surgery. In addition the committee agreed that there is an argument that acute pain is a predictor of chronic pain and therefore reducing postoperative pain may future chronic pain. There are adverse events that are key decision making outcomes for the people undergoing joint replacement surgery. These are thromboembolic complications, neurocognitive decline, phrenic nerve injury, and brachial plexus injury.</p><p>Important outcomes are postoperative use of analgesia, length of stay, nausea, and mobilisation within 24 hours after surgery. Postoperative use of analgesia is an indirect indicator of postoperative pain and as such is a useful measure for anaesthetic approach. Reduced length of stay is very important to those undergoing surgery and has economic implications. The anaesthetic approach may impact on when a person can mobilise after surgery. A person’s ability mobilise shortly after surgery represents the early experience of joint replacement and also whether they can be discharged from hospital.</p></div><div id="niceng157er6.s1.7.1.2"><h5>1.7.1.2. The quality of the evidence</h5><p>In outcomes where it was possible to assess using GRADE methodology, all but 1 were deemed to be of very low quality. The 2 outcomes not graded were assessed to be at very high risk of bias. The outcomes from the 3 randomised controlled trials were at risk of bias often due to unclear allocation concealment and also due to lack of blinding for subjective outcomes. 2 RCTs did not state that general anaesthesia was used in the studies though this was stated to be the only possibility by a committee member. Both study outcomes were judged to be a higher risk of bias due to this omission. The non-randomised study outcomes were commonly downgraded due to lack of comparability of care between groups. Most outcomes across the evidence review were also downgraded for imprecision.</p></div><div id="niceng157er6.s1.7.1.3"><h5>1.7.1.3. Benefits and harms</h5><p>5 studies covering 3 comparisons were found for this evidence review. 3 randomised controlled trials evaluated general anaesthesia with LIA versus general anaesthesia with regional analgesia. A non-randomised study investigated regional anaesthesia versus general anaesthesia with or without regional blockade and a further non-randomised study looked at general anaesthesia with peripheral nerve block versus general anaesthesia.</p><p>General anaesthesia with LIA versus general anaesthesia with regional analgesia found a benefit for general anaesthesia with LIA in thromboembolic complications and phrenic nerve palsy. There was a benefit for general anaesthesia with regional analgesia in postoperative pain and median postoperative use of analgesia. No difference was seen in a further postoperative use of analgesia outcome and for 2 length of stay outcomes. The committee discussed the two outcomes favouring general anaesthesia with LIA, both were adverse events and involved low numbers of events. The thromboembolic complication outcome was 1 pulmonary embolism that occurred and thromboembolic complications are not overtly associated with regional anaesthesia. Therefore the committee concluded that this could well have been an event that happened by chance and may not have been associated with the anaesthesia treatment. However phrenic nerve palsy is a direct procedural complication associated with interscalene brachial plexus block (ISB) (regional anaesthesia) and there were 2 events across the 2 studies. The committee agreed to that it was reasonable to say these results are not simply down to chance and are a negative effect of regional anaesthesia that should be considered. The phrenic nerve is often blocked as a side effect of interscalene brachial plexus block, but the impact of this is likely to last less than 24 hours. Neuropraxia and permanent damage to the phrenic nerve are rare but can cause long-term effects on respiratory function.</p><p>The committee spoke about the mean pain outcome taken from 2 RCTs. Both studies indicated a benefit for general anaesthesia with regional analgesia in pain 8 hours after surgery. However both studies also indicated a reversal in this by 24 hours after surgery when general anaesthesia with LIA had less pain. 24 hours after surgery the analgesic effects of the general anaesthesia and the nerve blocks and the LIA would not be present. The committee conjectured that both forms of anaesthesia having worn off after 24 hours then the groups must have had differing analgesic routines. These may well have not been planned or stated differences but it could have been that due to the people in the LIA group having more pain in the early hours of recovery, they are topped up with analgesia more readily than those in the regional analgesia group. This increased pain may have led to the clinically insignificant increased length of stay in the regional analgesia group.</p><p>The regional anaesthesia versus general anaesthesia with or without regional blockade comparison was taken from observational data in a propensity score matched group of 1824 people. A benefit of regional anaesthesia was found for readmission and a benefit of general anaesthesia with or without regional blockade in terms of thromboembolic complications. The benefit in terms of readmission made sense to the committee because respiratory complications from general anaesthesia could drive readmission. No difference was found in length of stay or gastrointestinal complications. The use of regional anaesthesia when not combined with general anaesthesia was considered by the committee to be a possible predictor of the future of anaesthesia in shoulder replacement surgery. The movement towards day surgery for shoulder replacement means that anaesthetic strategies that allow for swifter discharge are of increased prominence. Regional anaesthesia when not combined with general anaesthesia can regularly lead to discharge on the same day supporting day surgery.</p><p>The final comparison was general anaesthesia with peripheral nerve block versus general anaesthesia in an observational cohort of over 17 thousand operations. Multivariate analysis was used to address issues of confounding. There was no difference between treatment arms for intensive care unit admission, pulmonary complications, or length of stay.</p><p>The committee spoke more generally about the practicalities of regional anaesthesia, ISBs can take anywhere from 5 minutes to 45 minutes to complete. The expectation of how long the block might take affects how surgery lists are put together and if it takes a long time to complete the block then surgeries might be delayed for a day and increasing the backlog. The committee agreed that this is dependent on how many anaesthetists are working in the operating room and how the surgery anaesthesia is organised.</p><p>Overall the committee did not feel the evidence or committee consensus supported recommending any specific anaesthetic approach. The benefits of general anaesthesia with LIA and regional anaesthesia with LIA were potentially offset by adverse events. However the committee recognised the importance of discussing different anaesthesia options with people having shoulder replacement surgery and recommended this.</p><p>In addition the committee did not feel the evidence as it currently stands adequately explores anaesthesia for shoulder joint replacement and made 2 research recommendations. Firstly the committee felt that the 3 RCTs investigating general anaesthesia with LIA versus general anaesthesia with regional analgesia were small and the outcomes were graded as very low quality. Therefore the committee has made a research recommendation to cover this important comparison with the additional important comparator, general with nerve block. Secondly the committee understands that regional anaesthesia alone allows for faster discharge and could allow for day case shoulder joint replacement. This may be the future of shoulder joint replacement and there is currently very little evidence using this intervention. The move towards this might allow for more day cases and research into this intervention could be prominent for the future shoulder replacement anaesthesia.</p></div></div><div id="niceng157er6.s1.7.2"><h4>1.7.2. Cost effectiveness and resource use</h4><p>No economic evidence was found for this population and as such, there was uncertainty about the cost effectiveness of the interventions. Unit costs for LIA and the addition of nerve block to an anaesthetic regimen were presented. The committee acknowledged that the presented unit costs for the addition of nerve blocks did not factor in any cost savings, However they were clearly a more expensive intervention than LIA.</p><p>Given the lack of evidence and uncertainty surrounding the augmentation of an anaesthetic regimen with nerve blocks, a threshold analysis was conducted. The analysis showed what gain in quality adjusted life years (QALY) and health related quality of life (HRQoL) is necessary for an anaesthetic regimen augmented with nerve block to be cost effective at a threshold of £20,000 per QALY. Three factors highlighted by the committee as variable across the NHS were explored in the analysis. These factors were the time it takes to administer the nerve block (5 minutes, 10 minutes and 30 minutes); the length of time that the nerve block has an effect for (24 hours, 3 days, 10 days and 30 days); and if the cost of theatre time should be included or not. The rationale for having theatre time included as a cost variable was that the committee suggested that if 2 anaesthetists are available a nerve block can be administered in the anaesthesia room, not incurring additional theatre time costs. Therefore, for scenarios where theatre time was not included, 2 consultant anaesthetists were costed in. Whereas when theatre time was included, only one consultant anaesthetist was costed in.</p><p>Outlined below is the QALY gain needed based on the time taken to administer the nerve block and whether or not theatre time was included:
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<ul><li class="half_rhythm"><div>Administration time 30 minutes with theatre time: 0.034</div></li><li class="half_rhythm"><div>Administration time 10 minutes with theatre time: 0.012</div></li><li class="half_rhythm"><div>Administration time 5 minutes with theatre time: 0.006</div></li><li class="half_rhythm"><div>Administration time 30 minutes with no theatre time: 0.006</div></li><li class="half_rhythm"><div>Administration time 10 minutes with no theatre time: 0.002</div></li><li class="half_rhythm"><div>Administration time 5 minutes with no theatre time: 0.002</div></li></ul></p><p>The gain in HRQoL necessary at range of time horizons for all scenarios listed in the bullet points above was calculated (24 hours, 3 days, 10 days and 30 days). The results indicated that for a number of scenarios; particularly when the time to administer was 30 minutes, the intervention effect was 24 hours and when the cost of theatre time was included; the likelihood of nerve blocks being cost effective was impossible given that the gain in HRQoL needed was greater than 1 (given the assumed scale ranges from 0 to 1). When the assumptions were softened to their respective middle values, the gain in HRQoL was often not impossible (the gain needed was less than 1) but improbable. Finally, when time to administer was 5 minutes, the intervention effect was 30 days and when theatre time was excluded, the gain in HRQoL and therefore cost-effectiveness was more realistic.</p><p>The committee acknowledged that the time required for administration and the inclusion of the cost of theatre time was dependent on the experience of the anaesthetist and if two anaesthetists are available, respectively. All combinations of personnel numbers and time taken for administration can be found on the NHS at present. The length of time that nerve blocks have an effect could be argued to be anything between a matter of hours to a lifetime. The analgesic effect of a nerve block is variable but may be up to 18 hours on average for shoulder replacements. However, a 24 hour time horizon may be the most appropriate when considering acute post-operative outcomes (for example, pain, post-operative nausea and vomiting). A longer effect duration of 10 days to 30 days may be most appropriate to account for the possible effect of anaesthetic choice on adverse clinical outcomes (for example post-operative morbidity and mortality). Lastly, an even longer time horizon would be needed to account for long term outcomes (such as chronic pain, opioid dependence and range of motion).</p><p>There was discussion as to whether the addition of nerve blocks requires additional theatre time, and therefore the associated costs, specific to the procedure. This was dependent on the presence of a second anaesthetist. If 2 anaesthetists are present during surgery a nerve block can be administered in the anaesthesia room, therefore not incurring additional theatre time. This would represent additional staff costs.</p><p>A nerve block may take up to 5 minutes to administer for those who are familiar with the procedure. There may be further additional time required initially for those who are not familiar with using nerve blocks. Some members of the committee shared experience of nerve block administration time being as high as 45 minutes, although this would be a rarity. The efficacy of nerve blocks is also dependent how experienced the anaesthetist is. As a result analgesics are often used pre-emptively which allows the majority of people to leave at 24 hours. Analgesics are relatively low cost drugs.</p><p>In comparison, LIA can be administered by the surgeon and is likely to take around 5 minutes. This would represent a neutral cost, in terms of theatre time, if the nerve block performed by the anaesthetist takes an equivalent time and is performed during usable theatre time (for example, it is not performed before the list start time or during the previous operation by a second anaesthetist or a “block team"). More hospitals are developing block teams who administer the blocks in the anaesthetic rooms or elsewhere during the previous operations, thereby not impacting on usable theatre time. If the nerve block is performed during usable theatre time but takes consistently longer than the time taken for the surgeon to administer LIA, LIA could be cost saving as a result of reduced theatre time.</p><p>In addition to the uncertainty regarding costs, the committee also thought there was uncertainty in the clinical evidence for the shoulder replacement population. Given this the committee were unable to recommend specific options. A consensus recommendation was made to discuss all of the options with people having primary elective shoulder replacement. This recommendation is not expected to have a significant resource impact as it will not change current practice</p></div></div></div><div id="niceng157er6.rl.r1"><h2 id="_niceng157er6_rl_r1_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="niceng157er6.ref1">Abildgaard
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JT, Lonergan
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KT, Tolan
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SJ, Kissenberth
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MJ, Hawkins
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RJ, Washburn
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R, 3rd
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et al. Liposomal bupivacaine versus indwelling interscalene nerve block for postoperative pain control in shoulder arthroplasty: A prospective randomized controlled trial. Journal of Shoulder and Elbow Surgery. 2017; 26(7):1175–1181 [<a href="https://pubmed.ncbi.nlm.nih.gov/28479257" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28479257</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="niceng157er6.ref2">Aksu
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R, Bicer
|
|
C, Ulgey
|
|
A, Bayram
|
|
A, Gunes
|
|
I, Guney
|
|
A
|
|
et al. Comparison of interscalene brachial plexus block and intra-articular local anesthetic administration on postoperative pain management in arthroscopic shoulder surgery. Brazilian Journal of Anesthesiology. 2015; 65(3):222–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/25842003" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25842003</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="niceng157er6.ref3">Angerame
|
|
MR, Ruder
|
|
JA, Odum
|
|
SM, Hamid
|
|
N. Pain and opioid use after total shoulder arthroplasty with injectable liposomal bupivacaine versus interscalene block. Orthopedics. 2017; 40(5):e806–e811 [<a href="https://pubmed.ncbi.nlm.nih.gov/28617519" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28617519</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="niceng157er6.ref4">Atchabahian
|
|
A, Schwartz
|
|
G, Hall
|
|
C, Lajam
|
|
C, Andreae
|
|
M. Regional analgesia for improvement of long‐term functional outcome after elective large joint replacement. Cochrane Database of Systematic Reviews
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|
2015, Issue 8. Art. No.: CD010278. DOI: 10.1002/14651858.CD010278.pub2. [<a href="/pmc/articles/PMC4566967/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4566967</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26269416" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26269416</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD010278.pub2" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="niceng157er6.ref5">Auyong
|
|
DB, Yuan
|
|
SC, Choi
|
|
DS, Pahang
|
|
JA, Slee
|
|
AE, Hanson
|
|
NA. A double-blind randomized comparison of continuous interscalene, supraclavicular, and suprascapular blocks for total shoulder arthroplasty. Regional Anesthesia and Pain Medicine. 2017; 42(3):302–309 [<a href="https://pubmed.ncbi.nlm.nih.gov/28272290" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28272290</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="niceng157er6.ref6">Axelsson
|
|
K, Gupta
|
|
A, Johanzon
|
|
E, Berg
|
|
E, Ekback
|
|
G, Rawal
|
|
N
|
|
et al. Intraarticular administration of ketorolac, morphine, and ropivacaine combined with intraarticular patient-controlled regional analgesia for pain relief after shoulder surgery: A randomized, double-blind study. Anesthesia and Analgesia. 2008; 106(1):328–33, table of contents [<a href="https://pubmed.ncbi.nlm.nih.gov/18165599" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18165599</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="niceng157er6.ref7">Balocco
|
|
AL, Van Zundert
|
|
PGE, Gan
|
|
SS, Gan
|
|
TJ, Hadzic
|
|
A. Extended release bupivacaine formulations for postoperative analgesia: An update. Current Opinion in Anaesthesiology. 2018; 31(5):636–642 [<a href="https://pubmed.ncbi.nlm.nih.gov/30074492" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30074492</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="niceng157er6.ref8">Beaudet
|
|
V, Williams
|
|
SR, Tetreault
|
|
P, Perrault
|
|
MA. Perioperative interscalene block versus intra-articular injection of local anesthetics for postoperative analgesia in shoulder surgery. Regional Anesthesia and Pain Medicine. 2008; 33(2):134–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/18299094" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18299094</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="niceng157er6.ref9">Bishop
|
|
JY, Sprague
|
|
M, Gelber
|
|
J, Krol
|
|
M, Rosenblatt
|
|
MA, Gladstone
|
|
J
|
|
et al. Interscalene regional anesthesia for shoulder surgery. Journal of Bone and Joint Surgery (American Volume). 2005; 87(5):974–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/15866958" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15866958</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="niceng157er6.ref10">Bjornholdt
|
|
KT, Jensen
|
|
JM, Bendtsen
|
|
TF, Soballe
|
|
K, Nikolajsen
|
|
L. Local infiltration analgesia versus continuous interscalene brachial plexus block for shoulder replacement pain: A randomized clinical trial. European Journal of Orthopaedic Surgery & Traumatology. 2015; 25(8):1245–52 [<a href="https://pubmed.ncbi.nlm.nih.gov/26276164" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26276164</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="niceng157er6.ref11">Boddu
|
|
C, Genza
|
|
A, McCann
|
|
PD. Bridging multimodal pain management provides 48-hour pain control in patients undergoing total shoulder replacement. Journal of Shoulder and Elbow Surgery. 2018; 27(6S):S65–S69 [<a href="https://pubmed.ncbi.nlm.nih.gov/29426743" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29426743</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="niceng157er6.ref12">Cao
|
|
X, Pan
|
|
F. Comparison of liposomal bupivacaine infiltration versus interscalene nerve block for pain control in total shoulder arthroplasty: A meta-analysis of randomized control trails. Medicine. 2017; 96(39):e8079 [<a href="/pmc/articles/PMC5626269/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5626269</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28953626" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28953626</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="niceng157er6.ref13">Choi
|
|
WJ, Choi
|
|
KT, Lee
|
|
JH, Lee
|
|
YY. Intermittent interscalene brachial plexus block vs. Continuous intraarticular infusion for the management of postoperative pain after shoulder surgery. Anesthesia and Pain Medicine. 2008; 3(3):162–166</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="niceng157er6.ref14">Codding
|
|
JL, Getz
|
|
CL. Pain management strategies in shoulder arthroplasty. Orthopedic Clinics of North America. 2018; 49(1):81–91 [<a href="https://pubmed.ncbi.nlm.nih.gov/29145989" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29145989</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="niceng157er6.ref15">Curtis
|
|
LA, Burns
|
|
A. Unit costs of health and social care 2018. Project report. Kent. University of Kent, 2018. Available from: <a href="https://kar.kent.ac.uk/70995/1/Unit%20Costs%202018%20-%20FINAL%20with%20bookmarks%20and%20covers%20%282%29.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://kar<wbr style="display:inline-block"></wbr>​.kent.ac.uk<wbr style="display:inline-block"></wbr>​/70995/1/Unit%20Costs<wbr style="display:inline-block"></wbr>​%202018%20-%20FINAL<wbr style="display:inline-block"></wbr>​%20with%20bookmarks<wbr style="display:inline-block"></wbr>​%20and%20covers%20%282%29.pdf</a></div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="niceng157er6.ref16">Desmet
|
|
M, Braems
|
|
H, Reynvoet
|
|
M, Plasschaert
|
|
S, Van Cauwelaert
|
|
J, Pottel
|
|
H
|
|
et al. I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: A prospective, randomized, placebo-controlled study. British Journal of Anaesthesia. 2013; 111(3):445–52 [<a href="https://pubmed.ncbi.nlm.nih.gov/23587875" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23587875</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="niceng157er6.ref17">Desmet
|
|
M, Vanneste
|
|
B, Reynvoet
|
|
M, Van Cauwelaert
|
|
J, Verhelst
|
|
L, Pottel
|
|
H
|
|
et al. A randomised controlled trial of intravenous dexamethasone combined with interscalene brachial plexus blockade for shoulder surgery. Anaesthesia. 2015; 70(10):1180–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/26082203" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26082203</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="niceng157er6.ref18">Ding
|
|
DY, Mahure
|
|
SA, Mollon
|
|
B, Shamah
|
|
SD, Zuckerman
|
|
JD, Kwon
|
|
YW. Comparison of general versus isolated regional anesthesia in total shoulder arthroplasty: A retrospective propensity-matched cohort analysis. Journal of Orthopaedics. 2017; 14(4):417–424 [<a href="/pmc/articles/PMC5537444/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5537444</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28794581" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28794581</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="niceng157er6.ref19">Dorman
|
|
BH, Conroy
|
|
JM, Duc
|
|
TA, Jr., Haynes
|
|
GR, Friedman
|
|
RJ. Postoperative analgesia after major shoulder surgery with interscalene brachial plexus blockade: Etidocaine versus bupivacaine. Southern Medical Journal. 1994; 87(4):502–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/8153780" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8153780</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="niceng157er6.ref20">Ekatodramis
|
|
G, Borgeat
|
|
A, Huledal
|
|
G, Jeppsson
|
|
L, Westman
|
|
L, Sjovall
|
|
J. Continuous interscalene analgesia with ropivacaine 2 mg/ml after major shoulder surgery. Anesthesiology. 2003; 98(1):143–50 [<a href="https://pubmed.ncbi.nlm.nih.gov/12502990" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12502990</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="niceng157er6.ref21">Eroglu
|
|
A, Uzunlar
|
|
H, Sener
|
|
M, Akinturk
|
|
Y, Erciyes
|
|
N. A clinical comparison of equal concentration and volume of ropivacaine and bupivacaine for interscalene brachial plexus anesthesia and analgesia in shoulder surgery. Regional Anesthesia and Pain Medicine. 2004; 29(6):539–43 [<a href="https://pubmed.ncbi.nlm.nih.gov/15635512" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15635512</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="niceng157er6.ref22">Flory
|
|
N, Van-Gessel
|
|
E, Donald
|
|
F, Hoffmeyer
|
|
P, Gamulin
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|
Z. Does the addition of morphine to brachial plexus block improve analgesia after shoulder surgery?
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British Journal of Anaesthesia. 1995; 75(1):23–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/7669462" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7669462</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="niceng157er6.ref23">Gabriel
|
|
RA, Beverly
|
|
A, Dutton
|
|
RP, Urman
|
|
RD. Patterns of intra-arterial blood pressure monitoring for patients undergoing total shoulder arthroplasty under general anesthesia: A retrospective analysis of 23,073 patients. Journal of Clinical Monitoring and Computing. 2017; 31(5):877–884 [<a href="https://pubmed.ncbi.nlm.nih.gov/27738950" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27738950</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="niceng157er6.ref24">Ghaleb
|
|
AH, Candido
|
|
KD, Dvoryansky
|
|
A. Anesthesia for shoulder surgery. Progress in Anesthesiology. 2004; 18(12):179–196</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="niceng157er6.ref25">Goebel
|
|
S, Stehle
|
|
J, Schwemmer
|
|
U, Reppenhagen
|
|
S, Rath
|
|
B, Gohlke
|
|
F. Interscalene brachial plexus block for open-shoulder surgery: A randomized, double-blind, placebo-controlled trial between single-shot anesthesia and patient-controlled catheter system. Archives of Orthopaedic and Trauma Surgery. 2010; 130(4):533–40 [<a href="https://pubmed.ncbi.nlm.nih.gov/19841925" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19841925</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="niceng157er6.ref26">Gohl
|
|
MR, Moeller
|
|
RK, Olson
|
|
RL, Vacchiano
|
|
CA. The addition of interscalene block to general anesthesia for patients undergoing open shoulder procedures. AANA Journal. 2001; 69(2):105–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/11759142" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11759142</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="niceng157er6.ref27">Gottschalk
|
|
A, Burmeister
|
|
MA, Radtke
|
|
P, Krieg
|
|
M, Farokhzad
|
|
F, Kreissl
|
|
S
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et al. Continuous wound infiltration with ropivacaine reduces pain and analgesic requirement after shoulder surgery. Anesthesia and Analgesia. 2003; 97(4):1086–91, table of contents [<a href="https://pubmed.ncbi.nlm.nih.gov/14500162" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14500162</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="niceng157er6.ref28">Grossi
|
|
P, Calliada
|
|
S, Braga
|
|
A, Caldara
|
|
P, D’Aloia
|
|
A, Coluccia
|
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R. Interscalene brachial plexus block combined with total intravenous anaesthesia and laryngeal mask airway for shoulder surgery. Anaesthesia. 1998; 53:(Suppl 2):20–1 [<a href="https://pubmed.ncbi.nlm.nih.gov/9659050" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9659050</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="niceng157er6.ref29">Guo
|
|
CW, Ma
|
|
JX, Ma
|
|
XL, Lu
|
|
B, Wang
|
|
Y, Tian
|
|
AX
|
|
et al. Supraclavicular block versus interscalene brachial plexus block for shoulder surgery: A meta-analysis of clinical control trials. International Journal of Surgery. 2017; 45:85–91 [<a href="https://pubmed.ncbi.nlm.nih.gov/28755885" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28755885</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="niceng157er6.ref30">Gwam
|
|
CU, Mistry
|
|
JB, Jha
|
|
P, Khlopas
|
|
A, Thomas
|
|
M, Chughtai
|
|
M
|
|
et al. Efficacy of adductor canal blockade compared to multimodal peri-articular analgesia following total knee arthroplasty. Surgical Technology International. 2017; 30:300–305 [<a href="https://pubmed.ncbi.nlm.nih.gov/28072900" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28072900</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="niceng157er6.ref31">Haasio
|
|
J, Tuominen
|
|
M, Rosenberg
|
|
PH. Continuous interscalene brachial plexus block during and after shoulder surgery. Annales Chirurgiae et Gynaecologiae. 1990; 79(2):103–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/2386358" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2386358</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="niceng157er6.ref32">Hamdani
|
|
M, Chassot
|
|
O, Fournier
|
|
R. Ultrasound-guided continuous interscalene block: the influence of local anesthetic background delivery method on postoperative analgesia after shoulder surgery: A randomized trial. Regional Anesthesia and Pain Medicine. 2014; 39(5):387–93 [<a href="https://pubmed.ncbi.nlm.nih.gov/24942849" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24942849</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="niceng157er6.ref33">Hamilton
|
|
GM, Ramlogan
|
|
R, Lui
|
|
A, McCartney
|
|
CJL, Abdallah
|
|
F, McIsaac
|
|
DI. Association of peripheral nerve blocks with postoperative outcomes in ambulatory shoulder surgery patients: A single-centre matched-cohort study. Canadian journal of anesthesia. 2019; 66(1):63–74 [<a href="https://pubmed.ncbi.nlm.nih.gov/30334192" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30334192</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="niceng157er6.ref34">Hannan
|
|
CV, Albrecht
|
|
MJ, Petersen
|
|
SA, Srikumaran
|
|
U. Liposomal bupivacaine vs interscalene nerve block for pain control after shoulder arthroplasty: A retrospective cohort analysis. American Journal of Orthopedics. 2016; 45(7):424–430 [<a href="https://pubmed.ncbi.nlm.nih.gov/28005096" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28005096</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>35.</dt><dd><div class="bk_ref" id="niceng157er6.ref35">Herrick
|
|
MD, Liu
|
|
H, Davis
|
|
M, Bell
|
|
JE, Sites
|
|
BD. Regional anesthesia decreases complications and resource utilization in shoulder arthroplasty patients. Acta Anaesthesiologica Scandinavica. 2018; 62(4):540–547 [<a href="https://pubmed.ncbi.nlm.nih.gov/29315474" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29315474</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>36.</dt><dd><div class="bk_ref" id="niceng157er6.ref36">Hofmann-Kiefer
|
|
K, Eiser
|
|
T, Chappell
|
|
D, Leuschner
|
|
S, Conzen
|
|
P, Schwender
|
|
D. Does patient-controlled continuous interscalene block improve early functional rehabilitation after open shoulder surgery?
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Anesthesia and Analgesia. 2008; 106(3):991–6, table of contents [<a href="https://pubmed.ncbi.nlm.nih.gov/18292451" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18292451</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="niceng157er6.ref37">Hong
|
|
JY, Lee
|
|
IH. Suprascapular nerve block or a piroxicam patch for shoulder tip pain after day case laparoscopic surgery. European Journal of Anaesthesiology. 2003; 20(3):234–238 [<a href="https://pubmed.ncbi.nlm.nih.gov/12650495" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12650495</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="niceng157er6.ref38">Huang
|
|
Y, Chiu
|
|
F, Webb
|
|
CA, Weyker
|
|
PD. Review of the evidence: Best analgesic regimen for shoulder surgery. Pain Management. 2017; 7(5):405–418 [<a href="https://pubmed.ncbi.nlm.nih.gov/28936915" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28936915</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="niceng157er6.ref39">Ikemoto
|
|
RY, Murachovsky
|
|
J, Prata Nascimento
|
|
LG, Bueno
|
|
RS, Oliveira Almeida
|
|
LH, Strose
|
|
E
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et al. Prospective randomized study comparing two anesthetic methods for shoulder surgery. Revista Brasileira de Ortopedia. 2010; 45(4):395–9 [<a href="/pmc/articles/PMC4799073/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4799073</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27022569" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27022569</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="niceng157er6.ref40">Ilfeld
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|
BM, Morey
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TE, Wright
|
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TW, Chidgey
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LK, Enneking
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FK. Continuous interscalene brachial plexus block for postoperative pain control at home: A randomized, double-blinded, placebo-controlled study. Anesthesia and Analgesia. 2003; 96(4):1089–95, table of contents [<a href="https://pubmed.ncbi.nlm.nih.gov/12651666" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12651666</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>41.</dt><dd><div class="bk_ref" id="niceng157er6.ref41">Ilfeld
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|
BM, Morey
|
|
TE, Wright
|
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TW, Chidgey
|
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LK, Enneking
|
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FK. Interscalene perineural ropivacaine infusion: A comparison of two dosing regimens for postoperative analgesia. Regional Anesthesia and Pain Medicine. 2004; 29(1):9–16 [<a href="https://pubmed.ncbi.nlm.nih.gov/14727272" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14727272</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>42.</dt><dd><div class="bk_ref" id="niceng157er6.ref42">Ilfeld
|
|
BM, Vandenborne
|
|
K, Duncan
|
|
PW, Sessler
|
|
DI, Enneking
|
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FK, Shuster
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JJ
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|
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KS, Kwon
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YS, Jung
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HJ, Lee
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JM, Kim
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JB, Park
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K. Comparison of intra-articular versus intra-venous patient controlled analgesia (PCA) following arthroscopic shoulder surgery. Korean Journal of Anesthesiology. 2007; 53(1):72–78</div></dd></dl><dl class="bkr_refwrap"><dt>44.</dt><dd><div class="bk_ref" id="niceng157er6.ref44">Jochum
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D, Roedel
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R, Gleyze
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JM. Interscalenic block and surgery of the shoulder. A prospective study of a continuous series of 167 patients. Annales Françaises d’Anesthésie et de Réanimation. 1997; 16(2):114–119 [<a href="https://pubmed.ncbi.nlm.nih.gov/9686071" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9686071</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>45.</dt><dd><div class="bk_ref" id="niceng157er6.ref45">Kahn
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RL, Hargett
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MJ. Beta-adrenergic blockers and vasovagal episodes during shoulder surgery in the sitting position under interscalene block. Anesthesia and Analgesia. 1999; 88(2):378–81 [<a href="https://pubmed.ncbi.nlm.nih.gov/9972760" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9972760</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>46.</dt><dd><div class="bk_ref" id="niceng157er6.ref46">Kim
|
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BG, Han
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JU, Song
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JH, Yang
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C, Lee
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BW, Baek
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JS. A comparison of ultrasound-guided interscalene and supraclavicular blocks for post-operative analgesia after shoulder surgery. Acta Anaesthesiologica Scandinavica. 2017; 61(4):427–435 [<a href="https://pubmed.ncbi.nlm.nih.gov/28164268" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28164268</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>47.</dt><dd><div class="bk_ref" id="niceng157er6.ref47">Kinnard
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P, Truchon
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R. Interscalene block for pain relief after shoulder surgery. A prospective randomized study. Journal of Bone and Joint Surgery (British Volume). 1995; 77–B(Suppl I):75</div></dd></dl><dl class="bkr_refwrap"><dt>48.</dt><dd><div class="bk_ref" id="niceng157er6.ref48">Kinnard
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P, Truchon
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R, St-Pierre
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A, Montreuil
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J. Interscalene block for pain relief after shoulder surgery. A prospective randomized study. Clinical Orthopaedics and Related Research. 1994; (304):22–4 [<a href="https://pubmed.ncbi.nlm.nih.gov/8020220" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8020220</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>49.</dt><dd><div class="bk_ref" id="niceng157er6.ref49">Kocamanoğlu
|
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IS, Kelsaka
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E, Malatyalioğlu
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E, Sarihasan
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B, Tür
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A, Sekerci
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B. Comparison of effects of the administration of intraperitoneal local anesthetics for postoperative analgesia and prevention of shoulder pain. Agri : Agri (Algoloji) Dernegi’nin Yayin organidir [Journal of the Turkish Society of Algology]. 2005; 17(4):53–57 [<a href="https://pubmed.ncbi.nlm.nih.gov/16552651" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16552651</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>50.</dt><dd><div class="bk_ref" id="niceng157er6.ref50">Kostadinova
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R, Belitova
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M. Continuous supraclaviculare brachial plexus block for postoperative pain control. Anaesthesiology and intensive care. 2009; 39(1):8–13</div></dd></dl><dl class="bkr_refwrap"><dt>51.</dt><dd><div class="bk_ref" id="niceng157er6.ref51">Krone
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SC, Chan
|
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VW, Regan
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J, Peng
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P, Poate
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EM, McCartney
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HM, Choi
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WJ, Choi
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KT. Comparison of intermittent versus continuous interscalene brachial plexus block for postoperative analgesia. Anesthesia and Pain Medicine. 2010; 5(2):111–114</div></dd></dl><dl class="bkr_refwrap"><dt>53.</dt><dd><div class="bk_ref" id="niceng157er6.ref53">Lehmann
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LJ, Loosen
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G, Weiss
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C, Schmittner
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MD. Interscalene plexus block versus general anaesthesia for shoulder surgery: A randomized controlled study. European Journal of Orthopaedic Surgery & Traumatology. 2015; 25(2):255–61 [<a href="https://pubmed.ncbi.nlm.nih.gov/24829053" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24829053</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>54.</dt><dd><div class="bk_ref" id="niceng157er6.ref54">Lehtipalo
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S, Koskinen
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LO, Johansson
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G, Kolmodin
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J, Biber
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B. Continuous interscalene brachial plexus block for postoperative analgesia following shoulder surgery. Acta Anaesthesiologica Scandinavica. 1999; 43(3):258–64 [<a href="https://pubmed.ncbi.nlm.nih.gov/10081530" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10081530</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>55.</dt><dd><div class="bk_ref" id="niceng157er6.ref55">Mahmoodpoor
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A, Abedini
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N, Parish
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M, Jannati
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A, Baradaran
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R. Efficacy of low dose Interscalene Brachial Plexus Block on post anesthesia recovery parameters after shoulder surgery. Pakistan Journal of Medical Sciences. 2011; 27(2):265–268</div></dd></dl><dl class="bkr_refwrap"><dt>56.</dt><dd><div class="bk_ref" id="niceng157er6.ref56">Mariano
|
|
ER, Afra
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R, Loland
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VJ, Sandhu
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NS, Bellars
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RH, Bishop
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ML
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EM, Blom
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AW, Lenguerrand
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E, Wylde
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V, Noble
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SM. Local anaesthetic wound infiltration in addition to standard anaesthetic regimen in total hip and knee replacement: long-term cost-effectiveness analyses alongside the APEX randomised controlled trials. BMC Medicine. 2015; 13:151 [<a href="/pmc/articles/PMC4496938/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4496938</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26116078" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26116078</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>58.</dt><dd><div class="bk_ref" id="niceng157er6.ref58">McLaughlin
|
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DC, Cheah
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JW, Aleshi
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P, Zhang
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AL, Ma
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CB, Feeley
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BT. Multimodal analgesia decreases opioid consumption after shoulder arthroplasty: A prospective cohort study. Journal of Shoulder and Elbow Surgery. 2018; 27(4):686–691 [<a href="https://pubmed.ncbi.nlm.nih.gov/29305103" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29305103</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>59.</dt><dd><div class="bk_ref" id="niceng157er6.ref59">Mueller
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KG, Memtsoudis
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SG, Mariano
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ER, Baker
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LC, Mackey
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S, Sun
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EC. Lack of association between the use of nerve blockade and the risk of persistent opioid use among patients undergoing shoulder arthroplasty: Evidence from the Marketscan Database. Anesthesia and Analgesia. 2017; 125(3):1014–1020 [<a href="https://pubmed.ncbi.nlm.nih.gov/28742777" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28742777</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>60.</dt><dd><div class="bk_ref" id="niceng157er6.ref60">Muittari
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O. The safety and efficacy of intrabursal oxycodone and bupivacaine in analgesia after shoulder surgery. Regional Anesthesia and Pain Medicine. 1998; 23(5):474–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/9773700" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9773700</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>61.</dt><dd><div class="bk_ref" id="niceng157er6.ref61">Namdari
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S, Nicholson
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T, Abboud
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J, Lazarus
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M, Steinberg
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D, Williams
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G. Randomized controlled trial of interscalene block compared with injectable liposomal bupivacaine in shoulder arthroplasty. Journal of Bone and Joint Surgery (American Volume). 2017; 99(7):550–556 [<a href="https://pubmed.ncbi.nlm.nih.gov/28375887" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28375887</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>62.</dt><dd><div class="bk_ref" id="niceng157er6.ref62">Namdari
|
|
S, Nicholson
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T, Abboud
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J, Lazarus
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M, Steinberg
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D, Williams
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G. Interscalene block with and without intraoperative local infiltration with liposomal bupivacaine in shoulder arthroplasty: A randomized controlled trial. Journal of Bone and Joint Surgery (American Volume). 2018; 100(16):1373–1378 [<a href="https://pubmed.ncbi.nlm.nih.gov/30106818" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30106818</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>63.</dt><dd><div class="bk_ref" id="niceng157er6.ref63">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual [updated 2018]. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.nice.org.uk<wbr style="display:inline-block"></wbr>​/article/PMG20/chapter<wbr style="display:inline-block"></wbr>​/1%20Introduction%20and%20overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>64.</dt><dd><div class="bk_ref" id="niceng157er6.ref64">National Institute for Health and Clinical Excellence. Hip fracture: management. London. 2011. Available from: <a href="https://www.nice.org.uk/guidance/cg124" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nice.org.uk/guidance/cg124</a></div></dd></dl><dl class="bkr_refwrap"><dt>65.</dt><dd><div class="bk_ref" id="niceng157er6.ref65">Niiya
|
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T, Yamauchi
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M, Mizukami
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N, Niiyama
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Y, Ohsone
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J, Honma
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|
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KR, Lynch
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JR, Keller
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RA, Korona
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J, Amato
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C, Rill
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LT, Lowry
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BP, Culp
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WC, Jr., Kitchings
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OE, Meyer
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TA, McAllister
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RK
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P. The effect of continuous interscalene brachial plexus block with 0.125% bupivacaine plus fentanyl on diaphragmatic motility and ventilatory function. Regional Anesthesia. 1993; 18(2):93–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/8489989" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8489989</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>70.</dt><dd><div class="bk_ref" id="niceng157er6.ref70">Renes
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SH, Rettig
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HC, Gielen
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MJ, Wilder-Smith
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OH, van Geffen
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GJ. Ultrasound-guided low-dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresis. Regional Anesthesia and Pain Medicine. 2009; 34(5):498–502 [<a href="https://pubmed.ncbi.nlm.nih.gov/19920426" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19920426</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>71.</dt><dd><div class="bk_ref" id="niceng157er6.ref71">Rosenfeld
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DM, Ivancic
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MG, Hattrup
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SJ, Renfree
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HD, Israel
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MA, Boltuch
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AD. Local injection of liposomal bupivacaine combined with intravenous dexamethasone reduces postoperative pain and hospital stay after shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2017; 26(4):641–647 [<a href="https://pubmed.ncbi.nlm.nih.gov/27856266" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27856266</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>73.</dt><dd><div class="bk_ref" id="niceng157er6.ref73">Sabesan
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VJ, Shahriar
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R, Petersen-Fitts
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GR, Whaley
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JD, Bou-Akl
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LA, Hans
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GH, Schepens
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T, Bosserez
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NM, Breebaart
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MB, Smitz
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CJ
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J, Klouche
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S, Conso
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C, Billot
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N, Auregan
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JC, Poulain
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PF, Hoy
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|
CF. Effect of phenylephrine on the haemodynamic state and cerebral oxygen saturation during anaesthesia in the upright position. British Journal of Anaesthesia. 2013; 111(2):229–34 [<a href="https://pubmed.ncbi.nlm.nih.gov/23518801" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23518801</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>78.</dt><dd><div class="bk_ref" id="niceng157er6.ref78">Song
|
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SY, Son
|
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SH, Kim
|
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SO, Roh
|
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WS. Intravenous fentanyl during shoulder arthroscopic surgery in the sitting position after interscalene block increases the incidence of episodes of bradycardia hypotension. Korean Journal of Anesthesiology. 2011; 60(5):344–50 [<a href="/pmc/articles/PMC3110293/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3110293</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21716907" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21716907</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>79.</dt><dd><div class="bk_ref" id="niceng157er6.ref79">Stevens
|
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MF, Werdehausen
|
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R, Golla
|
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E, Braun
|
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S, Hermanns
|
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H, Ilg
|
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A
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et al. Does interscalene catheter placement with stimulating catheters improve postoperative pain or functional outcome after shoulder surgery? A prospective, randomized and double-blinded trial. Anesthesia and Analgesia. 2007; 104(2):442–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/17242107" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17242107</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>80.</dt><dd><div class="bk_ref" id="niceng157er6.ref80">Stundner
|
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O, Meissnitzer
|
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M, Brummett
|
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CM, Moser
|
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S, Forstner
|
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R, Kokofer
|
|
A
|
|
et al. Comparison of tissue distribution, phrenic nerve involvement, and epidural spread in standard- vs low-volume ultrasound-guided interscalene plexus block using contrast magnetic resonance imaging: A randomized, controlled trial. British Journal of Anaesthesia. 2016; 116(3):405–12 [<a href="https://pubmed.ncbi.nlm.nih.gov/26865133" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26865133</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>81.</dt><dd><div class="bk_ref" id="niceng157er6.ref81">Stundner
|
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O, Rasul
|
|
R, Chiu
|
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YL, Sun
|
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X, Mazumdar
|
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M, Brummett
|
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CM
|
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et al. Peripheral nerve blocks in shoulder arthroplasty: How do they influence complications and length of stay?
|
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Clinical Orthopaedics and Related Research. 2014; 472:1482–8 [<a href="/pmc/articles/PMC3971209/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3971209</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24166076" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24166076</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>82.</dt><dd><div class="bk_ref" id="niceng157er6.ref82">Sun
|
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H, Li
|
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S, Wang
|
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K, Zhou
|
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J, Wu
|
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G, Fang
|
|
S
|
|
et al. Do liposomal bupivacaine infiltration and interscalene nerve block provide similar pain relief after total shoulder arthroplasty: A systematic review and meta-analysis. Journal of Pain Research. 2018; 11:1889–1900 [<a href="/pmc/articles/PMC6151095/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6151095</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30271195" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30271195</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>83.</dt><dd><div class="bk_ref" id="niceng157er6.ref83">Tamosiūnas
|
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R, Gudas
|
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R, Karbonskiene
|
|
A, Marchertiene
|
|
I. Bupivacaine for continuous interscalene brachial plexus analgesia after shoulder surgery. Medicina (Kaunas, Lithuania). 2004; 40(4):351–357 [<a href="https://pubmed.ncbi.nlm.nih.gov/15111749" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15111749</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>84.</dt><dd><div class="bk_ref" id="niceng157er6.ref84">Tantry
|
|
TP, Karanth
|
|
H, Shenoy
|
|
SP, Ayya
|
|
SV, Shetty
|
|
PK, Adappa
|
|
KK. Isoflurane versus sevoflurane with interscalene block for shoulder arthroscopic procedures: Value of process capability indices as an additional tool for data analysis. Indian Journal of Anaesthesia. 2016; 60(12):939–947 [<a href="/pmc/articles/PMC5168898/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5168898</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28003697" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28003697</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>85.</dt><dd><div class="bk_ref" id="niceng157er6.ref85">Tashjian
|
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RZ, Lilly
|
|
DT, Isaacson
|
|
AM, Georgopoulos
|
|
CE, Bettwieser
|
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SP, Burks
|
|
RT
|
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et al. Incidence of and risk factors for symptomatic venous thromboembolism after shoulder arthroplasty. American Journal of Orthopedics. 2016; 45(6):E379–E385 [<a href="https://pubmed.ncbi.nlm.nih.gov/27737296" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27737296</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>86.</dt><dd><div class="bk_ref" id="niceng157er6.ref86">Tetzlaff
|
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JE, Yoon
|
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HJ, Brems
|
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J, Javorsky
|
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T. Alkalinization of mepivacaine improves the quality of motor block associated with interscalene brachial plexus anesthesia for shoulder surgery. Regional Anesthesia. 1995; 20(2):128–32 [<a href="https://pubmed.ncbi.nlm.nih.gov/7605759" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7605759</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>87.</dt><dd><div class="bk_ref" id="niceng157er6.ref87">Trabelsi
|
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W, Ben Gabsia
|
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A, Lebbi
|
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A, Sammoud
|
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W, Labbene
|
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I, Ferjani
|
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M. Suprascapular block associated with supraclavicular block: An alternative to isolated interscalene block for analgesia in shoulder instability surgery?
|
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Orthopaedics & Traumatology, Surgery & Research. 2017; 103(1):77–83 [<a href="https://pubmed.ncbi.nlm.nih.gov/27916737" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27916737</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>88.</dt><dd><div class="bk_ref" id="niceng157er6.ref88">Trabelsi
|
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W, Romdhani
|
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C, Elaskri
|
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H, Ben Salah
|
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M, Sammoud
|
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W, Labbene
|
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I
|
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et al. Ultrasound-guided interscalene continuous block: Has the position of the tip an impact on the analgesia? Prospective randomized study. Anesthésie & Réanimation. 2015; 1(3):213–220</div></dd></dl><dl class="bkr_refwrap"><dt>89.</dt><dd><div class="bk_ref" id="niceng157er6.ref89">Tran
|
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DQ, Elgueta
|
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MF, Aliste
|
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J, Finlayson
|
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RJ. Diaphragm-sparing nerve blocks for shoulder surgery. Regional Anesthesia and Pain Medicine. 2017; 42(1):32–38 [<a href="https://pubmed.ncbi.nlm.nih.gov/27941477" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27941477</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>90.</dt><dd><div class="bk_ref" id="niceng157er6.ref90">Ullah
|
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H, Samad
|
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K, Khan
|
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F. Continuous interscalene brachial plexus block versus parenteral analgesia for postoperative pain relief after major shoulder surgery. Cochrane Database of Systematic Reviews
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2014, Issue 2. Art. No.: CD007080. DOI: 10.1002/14651858.CD007080.pub2. [<a href="/pmc/articles/PMC7182311/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7182311</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24492959" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24492959</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD007080.pub2" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>91.</dt><dd><div class="bk_ref" id="niceng157er6.ref91">Verelst
|
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P, Van Zundert
|
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A. Respiratory impact of analgesic strategies for shoulder surgery. Regional Anesthesia and Pain Medicine. 2013; 38(1):50–53 [<a href="https://pubmed.ncbi.nlm.nih.gov/23132510" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23132510</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>92.</dt><dd><div class="bk_ref" id="niceng157er6.ref92">Vorobeichik
|
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L, Brull
|
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R, Bowry
|
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R, Laffey
|
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JG, Abdallah
|
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FW. Should continuous rather than single-injection interscalene block be routinely offered for major shoulder surgery? A meta-analysis of the analgesic and side-effects profiles. British Journal of Anaesthesia. 2018; 120(4):679–692 [<a href="https://pubmed.ncbi.nlm.nih.gov/29576109" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29576109</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>93.</dt><dd><div class="bk_ref" id="niceng157er6.ref93">Warrender
|
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WJ, Syed
|
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UAM, Hammoud
|
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S, Emper
|
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W, Ciccotti
|
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MG, Abboud
|
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JA
|
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et al. Pain management after outpatient shoulder arthroscopy: A systematic review of randomized controlled trials. American Journal of Sports Medicine. 2017; 45(7):1676–1686 [<a href="https://pubmed.ncbi.nlm.nih.gov/27729319" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27729319</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>94.</dt><dd><div class="bk_ref" id="niceng157er6.ref94">Weller
|
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WJ, Azzam
|
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MG, Smith
|
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RA, Azar
|
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FM, Throckmorton
|
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TW. Liposomal bupivacaine mixture has similar pain relief and significantly fewer complications at less cost compared to indwelling interscalene catheter in total shoulder arthroplasty. Journal of Arthroplasty. 2017; 32(11):3557–3562 [<a href="https://pubmed.ncbi.nlm.nih.gov/28390888" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28390888</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>95.</dt><dd><div class="bk_ref" id="niceng157er6.ref95">Wiegel
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M, Moriggl
|
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B, Schwarzkopf
|
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P, Petroff
|
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D, Reske
|
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AW. Anterior suprascapular nerve block versus interscalene brachial plexus block for shoulder surgery in the outpatient setting: A randomized controlled patient- and assessor-blinded trial. Regional Anesthesia and Pain Medicine. 2017; 42(3):310–318 [<a href="https://pubmed.ncbi.nlm.nih.gov/28257388" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28257388</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>96.</dt><dd><div class="bk_ref" id="niceng157er6.ref96">Wiesmann
|
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T, Feldmann
|
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C, Muller
|
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HH, Nentwig
|
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L, Beermann
|
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A, El-Zayat
|
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BF
|
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et al. Phrenic palsy and analgesic quality of continuous supraclavicular vs. interscalene plexus blocks after shoulder surgery. Acta Anaesthesiologica Scandinavica. 2016; 60(8):1142–51 [<a href="https://pubmed.ncbi.nlm.nih.gov/27098548" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27098548</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>97.</dt><dd><div class="bk_ref" id="niceng157er6.ref97">Wurm
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WH, Concepcion
|
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M, Sternlicht
|
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A, Carabuena
|
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JM, Robelen
|
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G, Goudas
|
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LC
|
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et al. Preoperative interscalene block for elective shoulder surgery: Loss of benefit over early postoperative block after patient discharge to home. Anesthesia and Analgesia. 2003; 97(6):1620–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/14633531" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14633531</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>98.</dt><dd><div class="bk_ref" id="niceng157er6.ref98">YaDeau
|
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JT, Gordon
|
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MA, Goytizolo
|
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EA, Lin
|
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Y, Fields
|
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KG, Goon
|
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AK
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et al. Buprenorphine, clonidine, dexamethasone, and ropivacaine for interscalene nerve blockade: A prospective, randomized, blinded, ropivacaine dose-response study. Pain Medicine. 2016; 17(5):940–60 [<a href="/pmc/articles/PMC6280991/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6280991</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26814246" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26814246</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>99.</dt><dd><div class="bk_ref" id="niceng157er6.ref99">Yan
|
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Z, Chen
|
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Z, Ma
|
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C. Liposomal bupivacaine versus interscalene nerve block for pain control after shoulder arthroplasty: A meta-analysis. Medicine. 2017; 96(27):e7226 [<a href="/pmc/articles/PMC5502145/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5502145</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28682872" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28682872</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>100.</dt><dd><div class="bk_ref" id="niceng157er6.ref100">Yang
|
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CW, Jung
|
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SM, Kang
|
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PS, Kwon
|
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HU, Cho
|
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CK, Lee
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Y
|
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et al. A randomized comparison of ropivacaine 0.1% and 0.2% for continuous interscalene block after shoulder surgery. Anesthesia and Analgesia. 2013; 116(3):730–3 [<a href="https://pubmed.ncbi.nlm.nih.gov/23400997" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23400997</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>101.</dt><dd><div class="bk_ref" id="niceng157er6.ref101">Yang
|
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CW, Jung
|
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SM, Kwon
|
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HU, Cho
|
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CK, Yi
|
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JW, Kim
|
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CW
|
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et al. A clinical comparison of continuous interscalene brachial plexus block with different basal infusion rates of 0.2% ropivacaine for shoulder surgery. Korean Journal of Anesthesiology. 2010; 59(1):27–33 [<a href="/pmc/articles/PMC2908223/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2908223</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20651995" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20651995</span></a>]</div></dd></dl></dl></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng157er6.appa"><h3>Appendix A. Review protocols</h3><p id="niceng157er6.appa.et1"><a href="/books/NBK561389/bin/niceng157er6-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 7. Review protocol: Anaesthesia for elective shoulder joint replacement</a><span class="small"> (PDF, 222K)</span></p><p id="niceng157er6.appa.tab1"><a href="/books/NBK561389/table/niceng157er6.appa.tab1/?report=objectonly" target="object" rid-ob="figobniceng157er6appatab1" class="figpopup">Table 8. Health economic review protocol</a></p></div><div id="niceng157er6.appb"><h3>Appendix B. Literature search strategies</h3><p>The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual.<a class="bibr" href="#niceng157er6.ref63" rid="niceng157er6.ref63"><sup>63</sup></a></p><p><i>For more detailed information, please see the</i>
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<a href="/books/NBK561389/bin/niceng157er6_bm1.pdf">Methodology Review</a>.</p><div id="niceng157er6.appb.s1"><h4>B.1. Clinical search literature search strategy</h4><p>Searches were constructed using a PICO framework where population (P) terms were combined with Intervention (I) and in some cases Comparison (C) terms. Outcomes (O) are rarely used in search strategies for interventions as these concepts may not be well described in title, abstract or indexes and therefore difficult to retrieve. Search filters were applied to the searches where appropriate.</p><p id="niceng157er6.appb.tab1"><a href="/books/NBK561389/table/niceng157er6.appb.tab1/?report=objectonly" target="object" rid-ob="figobniceng157er6appbtab1" class="figpopup">Table 9. Database date parameters and filters used</a></p><p id="niceng157er6.appb.tab2"><a href="/books/NBK561389/table/niceng157er6.appb.tab2/?report=objectonly" target="object" rid-ob="figobniceng157er6appbtab2" class="figpopup">Medline (Ovid) search terms</a></p><p id="niceng157er6.appb.tab3"><a href="/books/NBK561389/table/niceng157er6.appb.tab3/?report=objectonly" target="object" rid-ob="figobniceng157er6appbtab3" class="figpopup">Embase (Ovid) search terms</a></p><p id="niceng157er6.appb.tab4"><a href="/books/NBK561389/table/niceng157er6.appb.tab4/?report=objectonly" target="object" rid-ob="figobniceng157er6appbtab4" class="figpopup">Cochrane Library (Wiley) search terms</a></p><p id="niceng157er6.appb.tab5"><a href="/books/NBK561389/table/niceng157er6.appb.tab5/?report=objectonly" target="object" rid-ob="figobniceng157er6appbtab5" class="figpopup">Epistemonikos search terms</a></p></div><div id="niceng157er6.appb.s2"><h4>B.2. Health Economics literature search strategy</h4><p>Health economic evidence was identified by conducting a broad search relating to the joint replacement population in NHS Economic Evaluation Database (NHS EED – this ceased to be updated after March 2015) and the Health Technology Assessment database (HTA) with no date restrictions. NHS EED and HTA databases are hosted by the Centre for Research and Dissemination (CRD). Additional health economics searches were run in Medline and Embase.</p><p id="niceng157er6.appb.tab6"><a href="/books/NBK561389/table/niceng157er6.appb.tab6/?report=objectonly" target="object" rid-ob="figobniceng157er6appbtab6" class="figpopup">Table 10. Database date parameters and filters used</a></p><p id="niceng157er6.appb.tab7"><a href="/books/NBK561389/table/niceng157er6.appb.tab7/?report=objectonly" target="object" rid-ob="figobniceng157er6appbtab7" class="figpopup">Medline (Ovid) search terms</a></p><p id="niceng157er6.appb.tab8"><a href="/books/NBK561389/table/niceng157er6.appb.tab8/?report=objectonly" target="object" rid-ob="figobniceng157er6appbtab8" class="figpopup">Embase (Ovid) search terms</a></p><p id="niceng157er6.appb.tab9"><a href="/books/NBK561389/table/niceng157er6.appb.tab9/?report=objectonly" target="object" rid-ob="figobniceng157er6appbtab9" class="figpopup">NHS EED and HTA (CRD) search terms</a></p></div></div><div id="niceng157er6.appc"><h3>Appendix C. Clinical evidence selection</h3><p id="niceng157er6.appc.fig1"><a href="/books/NBK561389/figure/niceng157er6.appc.fig1/?report=objectonly" target="object" rid-ob="figobniceng157er6appcfig1" class="figpopup">Figure 1. Flow chart of clinical study selection for the review of Anaesthesia for elective shoulder joint replacement</a></p></div><div id="niceng157er6.appd"><h3>Appendix D. Clinical evidence tables</h3><p id="niceng157er6.appd.et1"><a href="/books/NBK561389/bin/niceng157er6-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (225K)</span></p></div><div id="niceng157er6.appe"><h3>Appendix E. Forest plots</h3><div id="niceng157er6.appe.s1"><h4>E.1. General anaesthesia with LIA versus general anaesthesia with regional anaesthesia</h4><p id="niceng157er6.appe.fig1"><a href="/books/NBK561389/figure/niceng157er6.appe.fig1/?report=objectonly" target="object" rid-ob="figobniceng157er6appefig1" class="figpopup">Figure 2. Postoperative pain</a></p><p id="niceng157er6.appe.fig2"><a href="/books/NBK561389/figure/niceng157er6.appe.fig2/?report=objectonly" target="object" rid-ob="figobniceng157er6appefig2" class="figpopup">Figure 3. Thromboembolic complications</a></p><p id="niceng157er6.appe.fig3"><a href="/books/NBK561389/figure/niceng157er6.appe.fig3/?report=objectonly" target="object" rid-ob="figobniceng157er6appefig3" class="figpopup">Figure 4. Phrenic nerve palsy</a></p><p id="niceng157er6.appe.fig4"><a href="/books/NBK561389/figure/niceng157er6.appe.fig4/?report=objectonly" target="object" rid-ob="figobniceng157er6appefig4" class="figpopup">Figure 5. Postoperative use of analgesia</a></p><p id="niceng157er6.appe.fig5"><a href="/books/NBK561389/figure/niceng157er6.appe.fig5/?report=objectonly" target="object" rid-ob="figobniceng157er6appefig5" class="figpopup">Figure 6. Length of stay</a></p><p>General anaesthesia with LIA versus general anaesthesia</p></div><div id="niceng157er6.appe.s2"><h4>E.2. Regional anaesthesia versus general anaesthesia with or without regional blockade</h4><p id="niceng157er6.appe.fig6"><a href="/books/NBK561389/figure/niceng157er6.appe.fig6/?report=objectonly" target="object" rid-ob="figobniceng157er6appefig6" class="figpopup">Figure 7. Readmission within 90 days</a></p><p id="niceng157er6.appe.fig7"><a href="/books/NBK561389/figure/niceng157er6.appe.fig7/?report=objectonly" target="object" rid-ob="figobniceng157er6appefig7" class="figpopup">Figure 8. Gastrointestinal complications</a></p><p id="niceng157er6.appe.fig8"><a href="/books/NBK561389/figure/niceng157er6.appe.fig8/?report=objectonly" target="object" rid-ob="figobniceng157er6appefig8" class="figpopup">Figure 9. Thromboembolic complications</a></p><p id="niceng157er6.appe.fig9"><a href="/books/NBK561389/figure/niceng157er6.appe.fig9/?report=objectonly" target="object" rid-ob="figobniceng157er6appefig9" class="figpopup">Figure 10. Length of stay</a></p></div><div id="niceng157er6.appe.s3"><h4>E.3. General anaesthesia with peripheral nerve block versus general anaesthesia</h4><p id="niceng157er6.appe.fig10"><a href="/books/NBK561389/figure/niceng157er6.appe.fig10/?report=objectonly" target="object" rid-ob="figobniceng157er6appefig10" class="figpopup">Figure 11. Intensive care unit admission</a></p><p id="niceng157er6.appe.fig11"><a href="/books/NBK561389/figure/niceng157er6.appe.fig11/?report=objectonly" target="object" rid-ob="figobniceng157er6appefig11" class="figpopup">Figure 12. Pulmonary complications</a></p><p id="niceng157er6.appe.fig12"><a href="/books/NBK561389/figure/niceng157er6.appe.fig12/?report=objectonly" target="object" rid-ob="figobniceng157er6appefig12" class="figpopup">Figure 13. Increased length of stay</a></p></div></div><div id="niceng157er6.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng157er6.appf.tab1"><a href="/books/NBK561389/table/niceng157er6.appf.tab1/?report=objectonly" target="object" rid-ob="figobniceng157er6appftab1" class="figpopup">Table 11. RCT evidence profile: General anaesthesia with LIA versus general anaesthesia with regional anaesthesia</a></p><p>
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<b>4 Outcome reported as a median and it was not possible to assess the precision or to calculate the absolute effect.</b>
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</p><p id="niceng157er6.appf.tab2"><a href="/books/NBK561389/table/niceng157er6.appf.tab2/?report=objectonly" target="object" rid-ob="figobniceng157er6appftab2" class="figpopup">Table 12. NRS evidence profile: Regional anaesthesia versus general anaesthesia with or without regional blockade</a></p><p id="niceng157er6.appf.tab3"><a href="/books/NBK561389/table/niceng157er6.appf.tab3/?report=objectonly" target="object" rid-ob="figobniceng157er6appftab3" class="figpopup">Table 13. NRS evidence profile: General anaesthesia with peripheral nerve block versus general anaesthesia</a></p></div><div id="niceng157er6.appg"><h3>Appendix G. Health economic evidence selection</h3><p id="niceng157er6.appg.fig1"><a href="/books/NBK561389/figure/niceng157er6.appg.fig1/?report=objectonly" target="object" rid-ob="figobniceng157er6appgfig1" class="figpopup">Figure 14. Flow chart of health economic study selection for the guideline</a></p></div><div id="niceng157er6.apph"><h3>Appendix H. Health economic evidence tables</h3><p>No studies were found</p></div><div id="niceng157er6.appi"><h3>Appendix I. Nerve block threshold analysis</h3><p>A threshold analysis was conducted in order to determine the likelihood of the addition of nerve block to any anaesthetic regimen being cost effective. The analysis was deemed necessary by the committee given the lack of health economic evidence about the addition of nerve block.</p><div id="niceng157er6.appi.s1"><h4>I.1. Method</h4><p>The analysis uses estimates of incremental cost to find what QALY or health related quality of life (HRQoL) gain is required at a given threshold of cost effectiveness. The threshold selected for this analysis was £20,000 in line with the NICE reference case. A range of incremental costs (see <a class="figpopup" href="/books/NBK561389/table/niceng157er6.appi.tab1/?report=objectonly" target="object" rid-figpopup="figniceng157er6appitab1" rid-ob="figobniceng157er6appitab1">Table 14</a>) driven by the time required to administer the nerve block (30 minutes, 10 minutes and 5 minutes) and if the cost of theatre time was incorporated (yes or no) were included in the analysis. The rationale for having theatre time included as a cost variable was that the committee suggested that if 2 anaesthetists are available a nerve block can be administered in the anaesthesia room, not incurring additional theatre time costs. Therefore, for scenarios where theatre time was not included, 2 consultant anaesthetists were costed in. Whereas when theatre time was included, only one consultant anaesthetist was costed in. The time required to administer a nerve block reflected the experience of the staff member in giving it, a quicker time equates to a more experienced staff member. These factors were investigated in line with the committee’s agreement that they were variable in current practice. Other resources used for nerve block administration were taken from CG124<a class="bibr" href="#niceng157er6.ref64" rid="niceng157er6.ref64"><sup>64</sup></a> and agreed by the committee.</p><p>The different incremental cost estimates were substituted into the equation for the incremental cost-effectiveness ratio (ICER). The equation was then rearranged (see equation below) to find the incremental QALY gain needed for the nerve block intervention to be cost effective at £20,000.</p><div class="pmc_disp_formula whole_rhythm clearfix" id="niceng157er6.appi.deq1"><div class="inline_block pmc_inline_block pmc_va_middle pmc_hide_overflow twelve_col">
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<math id="niceng157er6.appi.eq1" display="block"><mtext mathvariant="italic">ICER</mtext><mtext> </mtext><mo>=</mo><mtext> </mtext><mtext mathvariant="italic">Incremental</mtext><mtext> </mtext><mtext mathvariant="italic">costs</mtext><mtext> </mtext><mo>÷</mo><mtext> </mtext><mtext mathvariant="italic">Incremental</mtext><mtext> </mtext><mtext mathvariant="italic">QALY</mtext></math>
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</div><div class="inline_block pmc_inline_block pmc_va_middle pmc_hide_overflow last bk_equ_label "><div><span class="nowrap"></span></div></div></div><p>Therefore:
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<div class="pmc_disp_formula whole_rhythm clearfix" id="niceng157er6.appi.deq2"><div class="inline_block pmc_inline_block pmc_va_middle pmc_hide_overflow twelve_col">
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<math id="niceng157er6.appi.eq2" display="block"><mtext mathvariant="italic">Incremental</mtext><mtext> </mtext><mtext mathvariant="italic">QALY</mtext><mtext> </mtext><mo>=</mo><mtext> </mtext><mtext mathvariant="italic">Incremental</mtext><mtext> </mtext><mtext mathvariant="italic">costs</mtext><mtext> </mtext><mo>÷</mo><mtext> </mtext><mtext mathvariant="italic">ICER</mtext></math>
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</div><div class="inline_block pmc_inline_block pmc_va_middle pmc_hide_overflow last bk_equ_label "><div><span class="nowrap"></span></div></div></div>
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</p><p>Following this an additional factor was analysed that was deemed variable by the committee; the time that nerve blocks have an effect upon people. The committee suggested that it could be argued the effect ranges from a matter of hours to a lifetime. The analgesic effect of a nerve block is variable but may be up to 18 hours for shoulder replacements. However, a 24 hour time horizon may be the most appropriate when considering acute post-operative outcomes (for example, pain, post-operative nausea and vomiting). A longer time horizon of 10 days to 30 days may be most appropriate to account for the possible effect of anaesthetic choice on adverse clinical outcomes (for example post-operative morbidity and mortality). Lastly, an even longer time horizon would be needed to account for long term outcomes (such as chronic pain, opioid dependence and range of motion). However, in line with the pain score outcome included in the protocol, the maximum effect horizon included in the analysis was 30 days. The different QALY gains calculated as outlined above were then substituted into the QALY equation with the different time horizons (24 hours, 3 days, 10 days and 30 days). The equation was then rearranged to find the gain in HRQoL gain needed to be cost effective at a threshold of £20,000 under each scenario.</p><div class="pmc_disp_formula whole_rhythm clearfix" id="niceng157er6.appi.deq3"><div class="inline_block pmc_inline_block pmc_va_middle pmc_hide_overflow twelve_col">
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<math id="niceng157er6.appi.eq3" display="block"><mtext mathvariant="italic">Incremental</mtext><mtext> </mtext><mtext mathvariant="italic">QALY</mtext><mtext> </mtext><mo>=</mo><mtext> </mtext><mtext mathvariant="italic">Incremental</mtext><mtext> </mtext><mtext mathvariant="italic">life</mtext><mtext> </mtext><mtext mathvariant="italic">years</mtext><mtext> </mtext><mtext mathvariant="italic">gained</mtext><mtext> </mtext><mo>×</mo><mtext> </mtext><mtext mathvariant="italic">Incremental</mtext><mtext> </mtext><mtext mathvariant="italic">utility</mtext><mtext> </mtext><mo stretchy="false">(</mo><mtext>HRQoL</mtext><mo stretchy="false">)</mo></math>
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</div><div class="inline_block pmc_inline_block pmc_va_middle pmc_hide_overflow last bk_equ_label "><div><span class="nowrap"></span></div></div></div><p>Therefore:
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<div class="pmc_disp_formula whole_rhythm clearfix" id="niceng157er6.appi.deq4"><div class="inline_block pmc_inline_block pmc_va_middle pmc_hide_overflow twelve_col">
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<math id="niceng157er6.appi.eq4" display="block"><mtext mathvariant="italic">Incremental</mtext><mtext> </mtext><mtext mathvariant="italic">utility</mtext><mtext> </mtext><mo stretchy="false">(</mo><mtext>HRQoL</mtext><mo stretchy="false">)</mo><mtext> </mtext><mo>=</mo><mtext> </mtext><mtext mathvariant="italic">Incremental</mtext><mtext> </mtext><mtext mathvariant="italic">QALY</mtext><mtext> </mtext><mo>÷</mo><mtext> </mtext><mtext mathvariant="italic">Incremental</mtext><mtext> </mtext><mtext mathvariant="italic">Life</mtext><mtext> </mtext><mtext mathvariant="italic">years</mtext><mtext> </mtext><mtext mathvariant="italic">gained</mtext></math>
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</div><div class="inline_block pmc_inline_block pmc_va_middle pmc_hide_overflow last bk_equ_label "><div><span class="nowrap"></span></div></div></div>
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</p><p>If the requisite HRQoL gain was greater than 1, then it was deemed not possible for the addition of nerve blocks to be cost effective under that scenario. The assumed scale of health related quality of life was 0 to 1 where 1 is the maximum health related quality of life and 0 the least. This was chosen as the NICE Reference case states to use the EQ-5D instrument that also uses a 0 to 1 scale. The smaller the gain needed in HRQoL, the more likely the addition of nerve block was to be cost effective.</p><p><a class="figpopup" href="/books/NBK561389/table/niceng157er6.appi.tab1/?report=objectonly" target="object" rid-figpopup="figniceng157er6appitab1" rid-ob="figobniceng157er6appitab1">Table 14</a> shows the unit costs used to calculate the cost for the addition of a nerve block to an anaesthetic regimen for a the different scenarios likely to represent current practice ion the NHS</p><p id="niceng157er6.appi.tab1"><a href="/books/NBK561389/table/niceng157er6.appi.tab1/?report=objectonly" target="object" rid-ob="figobniceng157er6appitab1" class="figpopup">Table 14. UK 2018 cost for the addition of a nerve block to an anaesthetic regimen for primary elective joint replacement when varying administration time and the inclusion of theatre time cost</a></p></div><div id="niceng157er6.appi.s2"><h4>I.2. Results</h4><p>The gain in QALY and gain in HRQoL needed under a range of different scenarios is shown in <a class="figpopup" href="/books/NBK561389/table/niceng157er6.appi.tab2/?report=objectonly" target="object" rid-figpopup="figniceng157er6appitab2" rid-ob="figobniceng157er6appitab2">Table 15</a>. For a number of scenarios; particularly when the time to administer was 30 minutes, the intervention effect was 24 hours and when theatre time was included; the likelihood of nerve blocks being cost effective was impossible given that the gain in HRQoL needed was greater than 1. When the assumptions were softened to the middle values, the gain in HRQoL was often not impossible (the gain needed was less than 1) but improbable. Finally, when time to administer was 5 minutes, the intervention effect was 30 days and when theatre time was excluded, the gain in HRQoL and therefore cost-effectiveness was more realistic.</p><p id="niceng157er6.appi.tab2"><a href="/books/NBK561389/table/niceng157er6.appi.tab2/?report=objectonly" target="object" rid-ob="figobniceng157er6appitab2" class="figpopup">Table 15. Threshold analysis results</a></p></div><div id="niceng157er6.appi.s3"><h4>I.3. Conclusions</h4><p>The results indicated that for some scenarios it is impossible for nerve blocks to be cost effective, for others cost effectiveness is improbable, whilst for some it is possible. Due to the lack of clinical evidence and uncertainty regarding cost effectiveness shown by this threshold analysis they made 2 research recommendations. One of these was to explore the clinical and cost effectiveness of supplementing general anaesthesia with a nerve block or LIA for shoulder replacement surgery. The second was to explore the clinical and cost effectiveness of regional and/or general anaesthesia for shoulder replacement surgery.</p></div></div><div id="niceng157er6.appj"><h3>Appendix J. Excluded studies</h3><div id="niceng157er6.appj.s1"><h4>J.1. Excluded clinical studies</h4><p id="niceng157er6.appj.tab1"><a href="/books/NBK561389/table/niceng157er6.appj.tab1/?report=objectonly" target="object" rid-ob="figobniceng157er6appjtab1" class="figpopup">Table 16. Studies excluded from the clinical review</a></p></div><div id="niceng157er6.appj.s2"><h4>J.2. Excluded health economic studies</h4><p id="niceng157er6.appj.tab2"><a href="/books/NBK561389/table/niceng157er6.appj.tab2/?report=objectonly" target="object" rid-ob="figobniceng157er6appjtab2" class="figpopup">Table 17. Studies excluded from the health economic review</a></p></div></div><div id="niceng157er6.appk"><h3>Appendix K. Research recommendations</h3><div id="niceng157er6.appk.s1"><h4>K.1. Supplementary anaesthesia in elective shoulder replacement</h4><p>
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<b>Research question: In adults having elective shoulder joint replacement with general anaesthesia, what is the clinical and cost effectiveness of supplementary local infiltration anaesthesia compared with a supplementary nerve block?</b>
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</p><p>
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<b>Why this is important:</b>
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</p><p>The number of people having shoulder replacement surgery is increasing year on year with over 6,500 people having their shoulder replaced in the UK in 2017. Most of these are elective procedures. There have been recent changes and variations in practice around which type of anaesthesia might offer the best outcomes for different patient groups. There is a cost implication with the type of anaesthesia used due to the time taken to carry out the different modes of anaesthesia.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng157er6appktab1"><a href="/books/NBK561389/table/niceng157er6.appk.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figniceng157er6appktab1" rid-ob="figobniceng157er6appktab1"><img class="small-thumb" src="/books/NBK561389/table/niceng157er6.appk.tab1/?report=thumb" src-large="/books/NBK561389/table/niceng157er6.appk.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="niceng157er6.appk.tab1"><a href="/books/NBK561389/table/niceng157er6.appk.tab1/?report=objectonly" target="object" rid-ob="figobniceng157er6appktab1">Table</a></h4><p class="float-caption no_bottom_margin">Population: People undergoing primary shoulder replacement surgery Intervention(s):
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General anaesthesia with LIA General anaesthesia with nerve blocks General anaesthesia with regional anaesthesia
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Comparison: a comparison of interventions General anaesthesia <a href="/books/NBK561389/table/niceng157er6.appk.tab1/?report=objectonly" target="object" rid-ob="figobniceng157er6appktab1">(more...)</a></p></div></div></div></div><div id="niceng157er6.appl"><h3>Appendix L. Research recommendations</h3><div id="niceng157er6.appl.s1"><h4>L.1. Regional compared with general anaesthesia or a combination in elective shoulder replacement</h4><p>
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<b>Research question: In adults having elective shoulder joint replacement, what is the relative clinical and cost effectiveness of general anaesthesia, regional anaesthesia, and general combined with regional anaesthesia?</b>
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</p><p>
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<b>Why this is important:</b>
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</p><p>The number of people having shoulder replacement surgery is increasing year on year with over 6,500 people having their shoulder replaced in the UK in 2017. Most of these are elective procedures. There have been recent changes and variations in practice around which type of anaesthesia might offer the best outcomes for different patient groups. The implications of utilising regional anaesthesia alone is to facilitate day-case shoulder replacement surgery in the NHS.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng157er6appltab1"><a href="/books/NBK561389/table/niceng157er6.appl.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figniceng157er6appltab1" rid-ob="figobniceng157er6appltab1"><img class="small-thumb" src="/books/NBK561389/table/niceng157er6.appl.tab1/?report=thumb" src-large="/books/NBK561389/table/niceng157er6.appl.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="niceng157er6.appl.tab1"><a href="/books/NBK561389/table/niceng157er6.appl.tab1/?report=objectonly" target="object" rid-ob="figobniceng157er6appltab1">Table</a></h4><p class="float-caption no_bottom_margin">Population: People undergoing primary shoulder replacement surgery Intervention(s):
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General anaesthesia Regional anaesthesia General anaesthesia with regional anaesthesia
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Comparison: a comparison of interventions General anaesthesia</p></div></div></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Intervention evidence review underpinning recommendation 1.3.3 in the NICE guideline</p><p>This evidence review was developed by the National Guideline Centre, hosted by the Royal College of Physicians</p></div><div><p><b>Disclaimer:</b> The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and, where appropriate, their carer or guardian.</p><p>Local commissioners and providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2020.</div><div class="small"><span class="label">Bookshelf ID: NBK561389</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/32881468" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">32881468</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng157er6tab1"><div id="niceng157er6.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng157er6.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng157er6.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adults having primary elective shoulder joint replacement</td></tr><tr><th id="hd_b_niceng157er6.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions</th><td headers="hd_b_niceng157er6.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>General anaesthesia</div></li><li class="half_rhythm"><div>General anaesthesia with local infiltration analgesia (LIA)</div></li><li class="half_rhythm"><div>General anaesthesia with regional anaesthesia (ultrasound guided ISB or other supraclavicular brachial plexus block)</div></li><li class="half_rhythm"><div>General anaesthesia with nerve block (not ISB or other supraclavicular brachial plexus block)</div></li><li class="half_rhythm"><div>General anaesthesia with nerve block (not ISB or other supraclavicular brachial plexus block) and local infiltration analgesia (LIA)</div></li><li class="half_rhythm"><div>Regional anaesthesia (ultrasound guided ISB or other supraclavicular brachial plexus block)</div></li></ul></td></tr><tr><th id="hd_b_niceng157er6.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_niceng157er6.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison of the interventions</td></tr><tr><th id="hd_b_niceng157er6.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng157er6.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Critical</b>
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<ul><li class="half_rhythm"><div>Mortality: within 90 days (dichotomous)</div></li><li class="half_rhythm"><div>Quality of life within 30 days (continuous)</div></li><li class="half_rhythm"><div>Postoperative pain within 30 days (continuous)</div></li><li class="half_rhythm"><div>Hospital readmission within 30 days (dichotomous)</div></li><li class="half_rhythm"><div>Adverse events:
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<ul class="circle"><li class="half_rhythm"><div>Thromboembolic complications within 90 days (VTE; dichotomous)</div></li><li class="half_rhythm"><div>Postoperative neurocognitive decline within 30 days (dichotomous)</div></li><li class="half_rhythm"><div>Phrenic nerve injury within 90 days (dichotomous)</div></li><li class="half_rhythm"><div>Brachial plexus injury within 90 days (dichotomous)</div></li></ul></div></li></ul>
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<b>Important</b>
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<ul><li class="half_rhythm"><div>Postoperative use of analgesia (dichotomous)</div></li><li class="half_rhythm"><div>Length of stay (continuous)</div></li><li class="half_rhythm"><div>Nausea within 30 days (dichotomous)</div></li><li class="half_rhythm"><div>Mobilisation within 24 hours after surgery</div></li></ul></td></tr><tr><th id="hd_b_niceng157er6.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng157er6.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
<p>Randomised controlled trials</p>
|
|
<p>If no well-conducted RCTs are available, then observational studies with multivariate analysis will be investigated. Multivariate analysis must account for ASA score and age.</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er6tab2"><div id="niceng157er6.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of studies included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng157er6.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention and comparison</th><th id="hd_h_niceng157er6.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng157er6.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th id="hd_h_niceng157er6.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><th headers="hd_h_niceng157er6.tab2_1_1_1_1 hd_h_niceng157er6.tab2_1_1_1_2 hd_h_niceng157er6.tab2_1_1_1_3 hd_h_niceng157er6.tab2_1_1_1_4 hd_h_niceng157er6.tab2_1_1_1_5" id="hd_b_niceng157er6.tab2_1_1_1_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">General anaesthesia with LIA versus general anaesthesia with regional anaesthesia</th></tr><tr><td headers="hd_h_niceng157er6.tab2_1_1_1_1 hd_b_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bjornholdt 2015<a class="bibr" href="#niceng157er6.ref10" rid="niceng157er6.ref10"><sup>10</sup></a></td><td headers="hd_h_niceng157er6.tab2_1_1_1_2 hd_b_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RCT</p>
|
|
<p>All people received general (total intravenous) anaesthesia. One group had LIA was using ropivacaine and epinephrine. The other group had an interscalene brachial plexus block with ropivacaine given just before surgery.</p>
|
|
</td><td headers="hd_h_niceng157er6.tab2_1_1_1_3 hd_b_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults scheduled for primary shoulder replacement</p>
|
|
<p>N=69</p>
|
|
<p>Mean (SD) age: 65 (8) and 66 (8)</p>
|
|
<p>ASA: I-III</p>
|
|
<p>Shoulder replacement: Anatomical total arthroplasty</p>
|
|
</td><td headers="hd_h_niceng157er6.tab2_1_1_1_4 hd_b_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Thromboembolic complications</div></li><li class="half_rhythm"><div>Suspected phrenic nerve palsy</div></li><li class="half_rhythm"><div>Postoperative use of analgesia</div></li><li class="half_rhythm"><div>Length of stay</div></li></ul></td><td headers="hd_h_niceng157er6.tab2_1_1_1_5 hd_b_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Denmark</td></tr><tr><td headers="hd_h_niceng157er6.tab2_1_1_1_1 hd_b_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Namdari 2017<a class="bibr" href="#niceng157er6.ref61" rid="niceng157er6.ref61"><sup>61</sup></a></td><td headers="hd_h_niceng157er6.tab2_1_1_1_2 hd_b_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RCT</p>
|
|
<p>All people received general anaesthesia. One group had intraoperative LIA with bupivacaine liposome in Exparel suspension. The other group had a preoperative ultrasound guided interscalene brachial plexus blockade using ropivacaine.</p>
|
|
</td><td headers="hd_h_niceng157er6.tab2_1_1_1_3 hd_b_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>People with osteoarthritis or rotator cuff tear arthroplasty scheduled for shoulder replacement</p>
|
|
<p>N=156</p>
|
|
<p>Mean (SD) age: 71 (9) and 68 (8)</p>
|
|
<p>ASA: Not stated</p>
|
|
<p>Shoulder replacement: Anatomical or reverse total arthroplasty</p>
|
|
</td><td headers="hd_h_niceng157er6.tab2_1_1_1_4 hd_b_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Postoperative pain</div></li><li class="half_rhythm"><div>Postoperative use of analgesia</div></li><li class="half_rhythm"><div>Length of stay</div></li></ul></td><td headers="hd_h_niceng157er6.tab2_1_1_1_5 hd_b_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>USA</p>
|
|
<p>The study did not state general anaesthesia was utilised however a committee clinical expert stated that general anaesthesia was the only possible anaesthesia given the other analgesic treatments.</p>
|
|
</td></tr><tr><td headers="hd_h_niceng157er6.tab2_1_1_1_1 hd_b_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Okoroha 2016<a class="bibr" href="#niceng157er6.ref66" rid="niceng157er6.ref66"><sup>66</sup></a></td><td headers="hd_h_niceng157er6.tab2_1_1_1_2 hd_b_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RCT</p>
|
|
<p>All people had general anaesthesia. One group had LIA using lipsomal bupivacaine in Exparel suspension. The other group had a single dose interscalene nerve block 1 hour before surgery using ropivacaine.</p>
|
|
</td><td headers="hd_h_niceng157er6.tab2_1_1_1_3 hd_b_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults undergoing primary shoulder replacement surgery.</p>
|
|
<p>N=57</p>
|
|
<p>Mean (range) age: 67 (49-86) and 69 (50-74)</p>
|
|
<p>ASA: not stated</p>
|
|
<p>Shoulder replacement: Anatomical or reverse total arthroplasty</p>
|
|
</td><td headers="hd_h_niceng157er6.tab2_1_1_1_4 hd_b_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Postoperative pain</div></li><li class="half_rhythm"><div>Phrenic nerve palsy requiring readmission</div></li><li class="half_rhythm"><div>Postoperative use of analgesia</div></li><li class="half_rhythm"><div>Length of stay</div></li></ul></td><td headers="hd_h_niceng157er6.tab2_1_1_1_5 hd_b_niceng157er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>USA</p>
|
|
<p>The study did not state general anaesthesia was utilised however a committee clinical expert stated that general anaesthesia was the only possible anaesthesia given the other analgesic treatments.</p>
|
|
</td></tr><tr><th headers="hd_h_niceng157er6.tab2_1_1_1_1 hd_h_niceng157er6.tab2_1_1_1_2 hd_h_niceng157er6.tab2_1_1_1_3 hd_h_niceng157er6.tab2_1_1_1_4 hd_h_niceng157er6.tab2_1_1_1_5" id="hd_b_niceng157er6.tab2_1_1_5_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Regional anaesthesia versus general anaesthesia with or without regional blockade</th></tr><tr><td headers="hd_h_niceng157er6.tab2_1_1_1_1 hd_b_niceng157er6.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ding 2017<a class="bibr" href="#niceng157er6.ref18" rid="niceng157er6.ref18"><sup>18</sup></a></td><td headers="hd_h_niceng157er6.tab2_1_1_1_2 hd_b_niceng157er6.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational data using New York Statewide Planning and Research Cooperative System (SPARCS) database to compare outcomes from people having regional anaesthesia to those having general anaesthesia with or without regional blockade</td><td headers="hd_h_niceng157er6.tab2_1_1_1_3 hd_b_niceng157er6.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>People who had total shoulder arthroplasty.</p>
|
|
<p>N=4158 were retrospectively propensity-matched using nearest-neighbour matching and including a total of 26 covariates. This led to using the data from N=1824</p>
|
|
<p>Mean (SD) age: 68 (10)</p>
|
|
<p>ASA: Not stated</p>
|
|
<p>Shoulder replacement: Anatomical or reverse total arthroplasty</p>
|
|
</td><td headers="hd_h_niceng157er6.tab2_1_1_1_4 hd_b_niceng157er6.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Readmission within 90 days</div></li><li class="half_rhythm"><div>Gastrointestinal complications</div></li><li class="half_rhythm"><div>Thromboembolic complications</div></li><li class="half_rhythm"><div>Length of stay</div></li></ul></td><td headers="hd_h_niceng157er6.tab2_1_1_1_5 hd_b_niceng157er6.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">USA</td></tr><tr><th headers="hd_h_niceng157er6.tab2_1_1_1_1 hd_h_niceng157er6.tab2_1_1_1_2 hd_h_niceng157er6.tab2_1_1_1_3 hd_h_niceng157er6.tab2_1_1_1_4 hd_h_niceng157er6.tab2_1_1_1_5" id="hd_b_niceng157er6.tab2_1_1_7_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">General anaesthesia with peripheral nerve block versus general anaesthesia</th></tr><tr><td headers="hd_h_niceng157er6.tab2_1_1_1_1 hd_b_niceng157er6.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Stundner 2014<a class="bibr" href="#niceng157er6.ref81" rid="niceng157er6.ref81"><sup>81</sup></a></td><td headers="hd_h_niceng157er6.tab2_1_1_1_2 hd_b_niceng157er6.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Observational data from the Premier database. An administrative database containing discharge information from about 400 acute-care hospitals.</p>
|
|
<p>All people had general anaesthesia. One group also with an upper-extremity nerve block.</p>
|
|
</td><td headers="hd_h_niceng157er6.tab2_1_1_1_3 hd_b_niceng157er6.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>People who had a total shoulder arthroplasty.</p>
|
|
<p>N=17157</p>
|
|
<p>Mean (95% CI) age: 69 (68-69) and 69 (69-69)</p>
|
|
<p>ASA: not stated</p>
|
|
<p>Shoulder replacement: unclear if reverse total arthroplasty included</p>
|
|
</td><td headers="hd_h_niceng157er6.tab2_1_1_1_4 hd_b_niceng157er6.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Readmission</div></li><li class="half_rhythm"><div>Pulmonary complications</div></li><li class="half_rhythm"><div>Length of stay</div></li></ul></td><td headers="hd_h_niceng157er6.tab2_1_1_1_5 hd_b_niceng157er6.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>USA</p>
|
|
<p>All analysis adjusted for age group, gender, ethnicity, Deyo index and presence of sleep apnoea and obesity.</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er6tab3"><div id="niceng157er6.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">RCT evidence summary: General anaesthesia with LIA versus general anaesthesia with regional anaesthesia</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng157er6.tab3_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng157er6.tab3_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng157er6.tab3_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng157er6.tab3_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_niceng157er6.tab3_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng157er6.tab3_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng157er6.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng157er6.tab3_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng157er6.tab3_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng157er6.tab3_1_1_1_5" id="hd_h_niceng157er6.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with General anaesthesia with regional anaesthesia</th><th headers="hd_h_niceng157er6.tab3_1_1_1_5" id="hd_h_niceng157er6.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with General anaesthesia with LIA (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er6.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng157er6.tab3_1_1_1_2 hd_h_niceng157er6.tab3_1_1_1_3 hd_h_niceng157er6.tab3_1_1_1_4 hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_1 hd_h_niceng157er6.tab3_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality of life</td><td headers="hd_h_niceng157er6.tab3_1_1_1_2 hd_h_niceng157er6.tab3_1_1_1_3 hd_h_niceng157er6.tab3_1_1_1_4 hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_1 hd_h_niceng157er6.tab3_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Postoperative pain Mean VAS. Scale from: 0 to 10.</td><td headers="hd_h_niceng157er6.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>213</p>
|
|
<p>(2 studies)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to risk of bias, inconsistency, imprecision</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean postoperative pain in the control groups was</p>
|
|
<p>2.7</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean postoperative pain in the intervention groups was</p>
|
|
<p>1.35 higher</p>
|
|
<p>(0.37 to 2.32 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng157er6.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hospital readmission</td><td headers="hd_h_niceng157er6.tab3_1_1_1_2 hd_h_niceng157er6.tab3_1_1_1_3 hd_h_niceng157er6.tab3_1_1_1_4 hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_1 hd_h_niceng157er6.tab3_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Thromboembolic complications Pulmonary embolism</td><td headers="hd_h_niceng157er6.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>65</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.13</p>
|
|
<p>(0 to 6.61)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31 per 1000</td><td headers="hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>27 fewer per 1000</p>
|
|
<p>(from 31 fewer to 145 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng157er6.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Postoperative neurocognitive decline</td><td headers="hd_h_niceng157er6.tab3_1_1_1_2 hd_h_niceng157er6.tab3_1_1_1_3 hd_h_niceng157er6.tab3_1_1_1_4 hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_1 hd_h_niceng157er6.tab3_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Phrenic nerve palsy Suspected or requiring readmission</td><td headers="hd_h_niceng157er6.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>122</p>
|
|
<p>(2 studies)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.14</p>
|
|
<p>(0.01 to 2.32)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32 per 1000</td><td headers="hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>27 fewer per 1000</p>
|
|
<p>(from 31 fewer to 39 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng157er6.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Brachial plexus injury</td><td headers="hd_h_niceng157er6.tab3_1_1_1_2 hd_h_niceng157er6.tab3_1_1_1_3 hd_h_niceng157er6.tab3_1_1_1_4 hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_1 hd_h_niceng157er6.tab3_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Postoperative use of analgesia</p>
|
|
<p>Narcotic consumption</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>213</p>
|
|
<p>(2 studies)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to risk of bias, inconsistency, imprecision</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean postoperative use of analgesia in the control groups was</p>
|
|
<p>17 morphine equivalent units</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean postoperative use of analgesia in the intervention groups was</p>
|
|
<p>3.33 lower</p>
|
|
<p>(9.04 lower to 2.74 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng157er6.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Postoperative use of analgesia<sup>4</sup></p>
|
|
<p>Median opioid consumption</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>65</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Deemed to be at very high risk of bias.</p>
|
|
<p>Imprecision unclear.</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_4 hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_1" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Median (IQR) in mg</p>
|
|
<p>General anaesthesia with LIA: 95 (170-150)</p>
|
|
<p>General anaesthesia with non-ISB nerve block: 40 (8-76)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not estimable</td></tr><tr><td headers="hd_h_niceng157er6.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Length of stay</td><td headers="hd_h_niceng157er6.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>213</p>
|
|
<p>(2 studies)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup><sup>,</sup><sup>3</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean length of stay in the control groups was</p>
|
|
<p>1.65 days</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean length of stay in the intervention groups was</p>
|
|
<p>0.17 lower</p>
|
|
<p>(0.37 lower to 0.03 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng157er6.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Median length of stay<sup>4</sup></td><td headers="hd_h_niceng157er6.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>65</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Deemed to be at very high risk of bias.</p>
|
|
<p>Imprecision unclear.</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_4 hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_1" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Median (range) in days</p>
|
|
<p>General anaesthesia with LIA: 2 (1-6)</p>
|
|
<p>General anaesthesia with non-ISB nerve block: 2 (1-3)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab3_1_1_1_5 hd_h_niceng157er6.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not estimable</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng157er6.tab3_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng157er6.tab3_2"><p class="no_margin">Downgraded by 1 or 2 increments because the point estimate varies widely across studies, unexplained by subgroup analysis. Random effects model used.</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng157er6.tab3_3"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs.</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="niceng157er6.tab3_4"><p class="no_margin">Outcome reported as a median and it was not possible to assess the precision or to calculate the absolute effect and therefore grade the overall quality..</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng157er6tab4"><div id="niceng157er6.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Non-randomised evidence summary: Regional anaesthesia versus general anaesthesia with or without regional blockade</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng157er6.tab4_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng157er6.tab4_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng157er6.tab4_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng157er6.tab4_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_niceng157er6.tab4_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng157er6.tab4_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng157er6.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng157er6.tab4_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng157er6.tab4_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng157er6.tab4_1_1_1_5" id="hd_h_niceng157er6.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with General anaesthesia with or without regional blockade</th><th headers="hd_h_niceng157er6.tab4_1_1_1_5" id="hd_h_niceng157er6.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Regional anaesthesia (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er6.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng157er6.tab4_1_1_1_2 hd_h_niceng157er6.tab4_1_1_1_3 hd_h_niceng157er6.tab4_1_1_1_4 hd_h_niceng157er6.tab4_1_1_1_5 hd_h_niceng157er6.tab4_1_1_2_1 hd_h_niceng157er6.tab4_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality of life</td><td headers="hd_h_niceng157er6.tab4_1_1_1_2 hd_h_niceng157er6.tab4_1_1_1_3 hd_h_niceng157er6.tab4_1_1_1_4 hd_h_niceng157er6.tab4_1_1_1_5 hd_h_niceng157er6.tab4_1_1_2_1 hd_h_niceng157er6.tab4_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Postoperative pain</td><td headers="hd_h_niceng157er6.tab4_1_1_1_2 hd_h_niceng157er6.tab4_1_1_1_3 hd_h_niceng157er6.tab4_1_1_1_4 hd_h_niceng157er6.tab4_1_1_1_5 hd_h_niceng157er6.tab4_1_1_2_1 hd_h_niceng157er6.tab4_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Readmission</td><td headers="hd_h_niceng157er6.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1824</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_niceng157er6.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.64</p>
|
|
<p>(0.43 to 0.96)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab4_1_1_1_5 hd_h_niceng157er6.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65 per 1000</td><td headers="hd_h_niceng157er6.tab4_1_1_1_5 hd_h_niceng157er6.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>23 fewer per 1000</p>
|
|
<p>(from 3 fewer to 37 fewer)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng157er6.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Thromboembolic complications DVT or PE</td><td headers="hd_h_niceng157er6.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1824</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_niceng157er6.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 2</p>
|
|
<p>(0.18 to 22.02)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab4_1_1_1_5 hd_h_niceng157er6.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 per 1000</td><td headers="hd_h_niceng157er6.tab4_1_1_1_5 hd_h_niceng157er6.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 more per 1000</p>
|
|
<p>(from 1 fewer to 23 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng157er6.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Postoperative neurocognitive decline</td><td headers="hd_h_niceng157er6.tab4_1_1_1_2 hd_h_niceng157er6.tab4_1_1_1_3 hd_h_niceng157er6.tab4_1_1_1_4 hd_h_niceng157er6.tab4_1_1_1_5 hd_h_niceng157er6.tab4_1_1_2_1 hd_h_niceng157er6.tab4_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Phrenic nerve injury</td><td headers="hd_h_niceng157er6.tab4_1_1_1_2 hd_h_niceng157er6.tab4_1_1_1_3 hd_h_niceng157er6.tab4_1_1_1_4 hd_h_niceng157er6.tab4_1_1_1_5 hd_h_niceng157er6.tab4_1_1_2_1 hd_h_niceng157er6.tab4_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Brachial plexus injury</td><td headers="hd_h_niceng157er6.tab4_1_1_1_2 hd_h_niceng157er6.tab4_1_1_1_3 hd_h_niceng157er6.tab4_1_1_1_4 hd_h_niceng157er6.tab4_1_1_1_5 hd_h_niceng157er6.tab4_1_1_2_1 hd_h_niceng157er6.tab4_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Length of stay</td><td headers="hd_h_niceng157er6.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1824</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng157er6.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng157er6.tab4_1_1_1_5 hd_h_niceng157er6.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean length of stay in the control groups was</p>
|
|
<p>2 days</p>
|
|
</td><td headers="hd_h_niceng157er6.tab4_1_1_1_5 hd_h_niceng157er6.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean length of stay in the intervention groups was</p>
|
|
<p>0.3 higher</p>
|
|
<p>(0.2 to 0.4 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng157er6.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nausea gastrointestinal complications</td><td headers="hd_h_niceng157er6.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1824</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng157er6.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RD 0</p>
|
|
<p>(0 to 0)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab4_1_1_1_5 hd_h_niceng157er6.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng157er6.tab4_1_1_1_5 hd_h_niceng157er6.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>0 fewer per 1000</p>
|
|
<p>(from 0 more to 0 more)<sup>3</sup></p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng157er6.tab4_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng157er6.tab4_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs.</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng157er6.tab4_3"><p class="no_margin">Absolute effect calculated using the risk difference.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng157er6tab5"><div id="niceng157er6.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Non-randomised evidence summary: General anaesthesia with peripheral nerve block versus general anaesthesia</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng157er6.tab5_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng157er6.tab5_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng157er6.tab5_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng157er6.tab5_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_niceng157er6.tab5_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng157er6.tab5_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng157er6.tab5_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng157er6.tab5_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng157er6.tab5_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng157er6.tab5_1_1_1_5" id="hd_h_niceng157er6.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with General anaesthesia</th><th headers="hd_h_niceng157er6.tab5_1_1_1_5" id="hd_h_niceng157er6.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with General anaesthesia with peripheral nerve block (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er6.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng157er6.tab5_1_1_1_2 hd_h_niceng157er6.tab5_1_1_1_3 hd_h_niceng157er6.tab5_1_1_1_4 hd_h_niceng157er6.tab5_1_1_1_5 hd_h_niceng157er6.tab5_1_1_2_1 hd_h_niceng157er6.tab5_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality of life</td><td headers="hd_h_niceng157er6.tab5_1_1_1_2 hd_h_niceng157er6.tab5_1_1_1_3 hd_h_niceng157er6.tab5_1_1_1_4 hd_h_niceng157er6.tab5_1_1_1_5 hd_h_niceng157er6.tab5_1_1_2_1 hd_h_niceng157er6.tab5_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Postoperative pain</td><td headers="hd_h_niceng157er6.tab5_1_1_1_2 hd_h_niceng157er6.tab5_1_1_1_3 hd_h_niceng157er6.tab5_1_1_1_4 hd_h_niceng157er6.tab5_1_1_1_5 hd_h_niceng157er6.tab5_1_1_2_1 hd_h_niceng157er6.tab5_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intensive care unit admission</td><td headers="hd_h_niceng157er6.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>17157</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>⊕⊝⊝⊝</p>
|
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<p>VERY LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_niceng157er6.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>OR 1.16</p>
|
|
<p>(0.93 to 1.45)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab5_1_1_1_5 hd_h_niceng157er6.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not estimable</td><td headers="hd_h_niceng157er6.tab5_1_1_1_5 hd_h_niceng157er6.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not estimable</td></tr><tr><td headers="hd_h_niceng157er6.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pulmonary complications pulmonary embolism, pneumonia, and pulmonary compromise</td><td headers="hd_h_niceng157er6.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>17157</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_niceng157er6.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>OR 0.87</p>
|
|
<p>(0.66 to 1.15)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab5_1_1_1_5 hd_h_niceng157er6.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not estimable</td><td headers="hd_h_niceng157er6.tab5_1_1_1_5 hd_h_niceng157er6.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not estimable</td></tr><tr><td headers="hd_h_niceng157er6.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Postoperative neurocognitive decline</td><td headers="hd_h_niceng157er6.tab5_1_1_1_2 hd_h_niceng157er6.tab5_1_1_1_3 hd_h_niceng157er6.tab5_1_1_1_4 hd_h_niceng157er6.tab5_1_1_1_5 hd_h_niceng157er6.tab5_1_1_2_1 hd_h_niceng157er6.tab5_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Phrenic nerve injury</td><td headers="hd_h_niceng157er6.tab5_1_1_1_2 hd_h_niceng157er6.tab5_1_1_1_3 hd_h_niceng157er6.tab5_1_1_1_4 hd_h_niceng157er6.tab5_1_1_1_5 hd_h_niceng157er6.tab5_1_1_2_1 hd_h_niceng157er6.tab5_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Brachial plexus injury</td><td headers="hd_h_niceng157er6.tab5_1_1_1_2 hd_h_niceng157er6.tab5_1_1_1_3 hd_h_niceng157er6.tab5_1_1_1_4 hd_h_niceng157er6.tab5_1_1_1_5 hd_h_niceng157er6.tab5_1_1_2_1 hd_h_niceng157er6.tab5_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Not reported</td></tr><tr><td headers="hd_h_niceng157er6.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Increased length of stay</td><td headers="hd_h_niceng157er6.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>17157</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊝⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng157er6.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 0.89</p>
|
|
<p>(0.82 to 0.97)</p>
|
|
</td><td headers="hd_h_niceng157er6.tab5_1_1_1_5 hd_h_niceng157er6.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not estimable</td><td headers="hd_h_niceng157er6.tab5_1_1_1_5 hd_h_niceng157er6.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not estimable</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng157er6.tab5_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng157er6.tab5_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng157er6tab6"><div id="niceng157er6.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">UK 2018 cost for the addition of a nerve block to an anaesthetic regimen for primary elective joint replacement when varying administration time and the inclusion of theatre time cost</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng157er6.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Extra time in theatre</th><th id="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Resource</th><th id="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Unit cost</th><th id="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Source</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_1" rowspan="12" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>5 min</b>
|
|
</td><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Biogel</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.07</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Chlorhexidine</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.08</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Vial with Lidocaine 1% 10ml ampoule</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.38</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">BNF</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Vial of 0.5% Levobupivacaine (5mg/ml)</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£3.88</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">BNF</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Syringes (10ml)</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.06</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Filter needle</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.23</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Regional block needle</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£5.78</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Hypodermic needle</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.35</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Cost per consultant anaesthetist (£1.80 per minute)</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£9.00</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">PSSRU 2018</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>Total cost excluding theatre time</b>
|
|
<sup>
|
|
(a)
|
|
</sup>
|
|
</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">
|
|
<b>£31.83</b>
|
|
</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Cost of theatre time (£20.50 per min)</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£102.50</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">CG124</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>Total cost including theatre time</b>
|
|
<sup>
|
|
(b)
|
|
</sup>
|
|
</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">
|
|
<b>£125.33</b>
|
|
</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_1" rowspan="12" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>10 min</b>
|
|
</td><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Biogel</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.07</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Chlorhexidine</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.08</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Vial with Lidocaine 1% 10ml ampoule</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.38</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">BNF</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Vial of 0.5% Levobupivacaine (5mg/ml)</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£3.88</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">BNF</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Syringes (10ml)</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.06</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Filter needle</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.23</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Regional block needle</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£5.78</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Hypodermic needle</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.35</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Cost per consultant anaesthetist (£1.80 per minute)</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£18.00</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">PSSRU 2018</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>Total cost excluding theatre time</b>
|
|
<sup>
|
|
(a)
|
|
</sup>
|
|
</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">
|
|
<b>£49.83</b>
|
|
</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Cost of theatre time (£20.50 per min)</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£205.00</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">CG124</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>Total cost including theatre time</b>
|
|
<sup>
|
|
(b)
|
|
</sup>
|
|
</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">
|
|
<b>£236.83</b>
|
|
</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_1" rowspan="12" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>30 min</b>
|
|
</td><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Biogel</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.07</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Chlorhexidine</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.08</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Vial with Lidocaine 1% 10ml ampoule</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.38</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">BNF</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Vial of 0.5% Levobupivacaine (5mg/ml)</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£3.88</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">BNF</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Syringes (10ml)</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.06</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Filter needle</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.23</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Regional block needle</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£5.78</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Hypodermic needle</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.35</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Cost per consultant anaesthetist (£1.80 per minute)</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£54.00</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">PSSRU 2018</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>Total cost excluding theatre time</b>
|
|
<sup>
|
|
(a)
|
|
</sup>
|
|
</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">
|
|
<b>£121.83</b>
|
|
</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Cost of theatre time (£20.50 per min)</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£615.00</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">CG124</td></tr><tr><td headers="hd_h_niceng157er6.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>Total cost including theatre time</b>
|
|
<sup>
|
|
(b)
|
|
</sup>
|
|
</td><td headers="hd_h_niceng157er6.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">
|
|
<b>£682.83</b>
|
|
</td><td headers="hd_h_niceng157er6.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: PSSRU (Personal Social Services Research Unit)<a class="bibr" href="#niceng157er6.ref15" rid="niceng157er6.ref15"><sup>15</sup></a>; CG124<a class="bibr" href="#niceng157er6.ref64" rid="niceng157er6.ref64"><sup>64</sup></a></p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng157er6.tab6_1"><p class="no_margin">Total costs excluding theatre time included the cost of 2 anaesthetists</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="niceng157er6.tab6_2"><p class="no_margin">It was assumed that the cost of theatre time from CG124<a class="bibr" href="#niceng157er6.ref64" rid="niceng157er6.ref64"><sup>64</sup></a> did not include personnel costs</p></div></dd></dl><dl class="bkr_refwrap"><dt>(c)</dt><dd><div id="niceng157er6.tab6_3"><p class="no_margin">NHS Hospital is Peterborough and Stamford Hospitals NHS Foundation Trust which provided information for CG124<a class="bibr" href="#niceng157er6.ref64" rid="niceng157er6.ref64"><sup>64</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng157er6appatab1"><div id="niceng157er6.appa.tab1" class="table"><h3><span class="label">Table 8</span><span class="title">Health economic review protocol</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appa.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appa.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng157er6.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Review question</th><th id="hd_h_niceng157er6.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">All questions – health economic evidence</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er6.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<b>Objectives</b>
|
|
</td><td headers="hd_h_niceng157er6.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">To identify health economic studies relevant to any of the review questions.</td></tr><tr><td headers="hd_h_niceng157er6.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<b>Search criteria</b>
|
|
</td><td headers="hd_h_niceng157er6.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Populations, interventions and comparators must be as specified in the clinical review protocol above.</div></li><li class="half_rhythm"><div>Studies must be of a relevant health economic study design (cost–utility analysis, cost-effectiveness analysis, cost–benefit analysis, cost–consequences analysis, comparative cost analysis).</div></li><li class="half_rhythm"><div>Studies must not be a letter, editorial or commentary, or a review of health economic evaluations. (Recent reviews will be ordered although not reviewed. The bibliographies will be checked for relevant studies, which will then be ordered.)</div></li><li class="half_rhythm"><div>Unpublished reports will not be considered unless submitted as part of a call for evidence.</div></li><li class="half_rhythm"><div>Studies must be in English.</div></li></ul></td></tr><tr><td headers="hd_h_niceng157er6.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<b>Search strategy</b>
|
|
</td><td headers="hd_h_niceng157er6.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A health economic study search will be undertaken using population-specific terms and a health economic study filter – see <a href="#niceng157er6.appb">appendix B</a> below.</td></tr><tr><td headers="hd_h_niceng157er6.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<b>Review strategy</b>
|
|
</td><td headers="hd_h_niceng157er6.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Studies not meeting any of the search criteria above will be excluded. Studies published before 2003, abstract-only studies and studies from low or middle-income countries (e.g. most non-OECD countries) or the USA will also be excluded.</p>
|
|
<p>Each remaining study will be assessed for applicability and methodological limitations using the NICE economic evaluation checklist which can be found in appendix H of Developing NICE guidelines: the manual (2014).<a class="bibr" href="#niceng157er6.ref63" rid="niceng157er6.ref63"><sup>63</sup></a></p>
|
|
<p><b>Inclusion and exclusion criteria</b>
|
|
<ul><li class="half_rhythm"><div>If a study is rated as both ‘Directly applicable’ and with ‘Minor limitations’ then it will be included in the guideline. A health economic evidence table will be completed and it will be included in the health economic evidence profile.</div></li><li class="half_rhythm"><div>If a study is rated as either ‘Not applicable’ or with ‘Very serious limitations’ then it will usually be excluded from the guideline. If it is excluded then a health economic evidence table will not be completed and it will not be included in the health economic evidence profile.</div></li><li class="half_rhythm"><div>If a study is rated as ‘Partially applicable’, with ‘Potentially serious limitations’ or both then there is discretion over whether it should be included.</div></li></ul>
|
|
<b>Where there is discretion</b></p>
|
|
<p>The health economist will make a decision based on the relative applicability and quality of the available evidence for that question, in discussion with the guideline committee if required. The ultimate aim is to include health economic studies that are helpful for decision-making in the context of the guideline and the current NHS setting. If several studies are considered of sufficiently high applicability and methodological quality that they could all be included, then the health economist, in discussion with the committee if required, may decide to include only the most applicable studies and to selectively exclude the remaining studies. All studies excluded on the basis of applicability or methodological limitations will be listed with explanation in the excluded health economic studies appendix below.</p>
|
|
<p>The health economist will be guided by the following hierarchies.</p>
|
|
<p><i>Setting:</i>
|
|
<ul><li class="half_rhythm"><div>UK NHS (most applicable).</div></li><li class="half_rhythm"><div>OECD countries with predominantly public health insurance systems (for example, France, Germany, Sweden).</div></li><li class="half_rhythm"><div>OECD countries with predominantly private health insurance systems (for example, Switzerland).</div></li><li class="half_rhythm"><div>Studies set in non-OECD countries or in the USA will be excluded before being assessed for applicability and methodological limitations.</div></li></ul>
|
|
<i>Health economic study type:</i>
|
|
<ul><li class="half_rhythm"><div>Cost–utility analysis (most applicable).</div></li><li class="half_rhythm"><div>Other type of full economic evaluation (cost–benefit analysis, cost-effectiveness analysis, cost–consequences analysis).</div></li><li class="half_rhythm"><div>Comparative cost analysis.</div></li><li class="half_rhythm"><div>Non-comparative cost analyses including cost-of-illness studies will be excluded before being assessed for applicability and methodological limitations.</div></li></ul>
|
|
<i>Year of analysis:</i>
|
|
<ul><li class="half_rhythm"><div>The more recent the study, the more applicable it will be.</div></li><li class="half_rhythm"><div>Studies published in 2003 or later but that depend on unit costs and resource data entirely or predominantly from before 2003 will be rated as ‘Not applicable’.</div></li><li class="half_rhythm"><div>Studies published before 2003 will be excluded before being assessed for applicability and methodological limitations.</div></li></ul>
|
|
<i>Quality and relevance of effectiveness data used in the health economic analysis:</i>
|
|
<ul><li class="half_rhythm"><div>The more closely the clinical effectiveness data used in the health economic analysis match with the outcomes of the studies included in the clinical review the more useful the analysis will be for decision-making in the guideline.</div></li></ul>
|
|
</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er6appbtab1"><div id="niceng157er6.appb.tab1" class="table"><h3><span class="label">Table 9</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng157er6.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database</th><th id="hd_h_niceng157er6.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dates searched</th><th id="hd_h_niceng157er6.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er6.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline (OVID)</td><td headers="hd_h_niceng157er6.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1946 – 01 May 2019</td><td headers="hd_h_niceng157er6.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Randomised controlled trials</p>
|
|
<p>Systematic review studies</p>
|
|
<p>Observational studies</p>
|
|
</td></tr><tr><td headers="hd_h_niceng157er6.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase (OVID)</td><td headers="hd_h_niceng157er6.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1974 – 01 May 2019</td><td headers="hd_h_niceng157er6.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Randomised controlled trials</p>
|
|
<p>Systematic review studies</p>
|
|
<p>Observational studies</p>
|
|
</td></tr><tr><td headers="hd_h_niceng157er6.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Cochrane Library (Wiley)</td><td headers="hd_h_niceng157er6.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Cochrane Reviews to 2019 Issue 5 of 12</p>
|
|
<p>CENTRAL to 2019 Issue 5 of 12</p>
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</td><td headers="hd_h_niceng157er6.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr><tr><td headers="hd_h_niceng157er6.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Epistemonikos</td><td headers="hd_h_niceng157er6.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inception – 01 May 2019</td><td headers="hd_h_niceng157er6.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er6appbtab2"><div id="niceng157er6.appb.tab2" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appb.tab2_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">arthroplasty/ or arthroplasty, replacement/ or arthroplasty, replacement, hip/ or arthroplasty, replacement, knee/ or arthroplasty, replacement, shoulder/ or hemiarthroplasty/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">joint prosthesis/ or hip prosthesis/ or knee prosthesis/ or shoulder prosthesis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((joint* or knee* or shoulder* or hip*) adj5 (surger* or replace* or prosthe* or endoprosthe* or implant* or artificial or arthroplast* or hemiarthroplast*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-3</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/5-12</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13 not 14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/15-21</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 not 22</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 23 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Anesthesia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((an?esthet* or an?esthesia) adj4 (regional* or local* or general or spinal or epidural)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nerve Block/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((nerve* or neurax* or regional or peripheral*) adj3 block*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((plexus or sciatic* or interscalene or femor* or tibia* or posterior or obturator or fascia iliaca) adj3 block).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(CNB or PNB or FNB or TNB or ONB or LPB or ISBB or FIB or LIA).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((periarticular or local*) adj2 infiltration).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/25-31</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24 and 32</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">controlled clinical trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomi#ed.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomly.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Clinical Trials as topic.sh.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">trial.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/34-40</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Meta-Analysis as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly* or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic* or evidence*) adj3 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search criteria or systematic search or study selection or data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4 literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/42-51</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Epidemiologic studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Cohort studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cohort adj (study or studies or analys* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((follow up or observational or uncontrolled or non randomi#ed or epidemiologic*) adj (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((longitudinal or retrospective or prospective or cross sectional) and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Controlled Before-After Studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Historically Controlled Study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interrupted Time Series Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(before adj2 after adj2 (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/54-63</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp case control study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case control*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/65-66</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or 67</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cross-sectional studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cross sectional and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/69-70</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">71.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or 71</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">72.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or 67 or 71</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">73.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">and (41 or 52 or 72)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er6appbtab3"><div id="niceng157er6.appb.tab3" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appb.tab3_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*arthroplasty/ or *replacement arthroplasty/ or *hip replacement/ or *knee replacement/ or *shoulder replacement/ or *hemiarthroplasty/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*joint prosthesis/ or *hip prosthesis/ or *knee prosthesis/ or *shoulder prosthesis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((joint* or knee* or shoulder* or hip*) adj5 (surger* or replace* or prosthe* or endoprosthe* or implant* or artificial or arthroplast* or hemiarthroplast*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-3</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/5-9</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 not 11</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/12-19</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 not 20</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 21 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*anesthesia/ or general anesthesia/ or regional anesthesia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((an?esthet* or an?esthesia) adj4 (regional* or local* or general or spinal or epidural)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nerve block/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((nerve* or neurax* or regional or peripheral*) adj3 block*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((plexus or sciatic* or interscalene or femor* or tibia* or posterior or obturator or fascia iliaca) adj3 block).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(CNB or PNB or FNB or TNB or ONB or LPB or ISBB or FIB or LIA).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((periarticular or local*) adj2 infiltration).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/23-29</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22 and 30</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">factorial*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(crossover* or cross over*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((doubl* or singl*) adj blind*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(assign* or allocat* or volunteer* or placebo*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">crossover procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">single blind procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">double blind procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/32-40</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">systematic review/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">meta-analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly* or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic* or evidence*) adj3 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search criteria or systematic search or study selection or data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4 literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/42-51</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Clinical study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">family study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">longitudinal study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">retrospective study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">prospective study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cohort analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">follow-up/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cohort*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61 and 62</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cohort adj (study or studies or analys* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((follow up or observational or uncontrolled or non randomi#ed or epidemiologic*) adj (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((longitudinal or retrospective or prospective or cross sectional) and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(before adj2 after adj2 (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/54-60,63-67</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp case control study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case control*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/69-70</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">71.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68 or 71</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">72.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cross-sectional study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">73.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cross sectional and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">74.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/73-74</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">75.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68 or 75</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">76.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68 or 71 or 75</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">77.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31 and (41 or 52 or 76)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er6appbtab4"><div id="niceng157er6.appb.tab4" class="table"><h3><span class="title">Cochrane Library (Wiley) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appb.tab4_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Arthroplasty] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Arthroplasty, Replacement] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Arthroplasty, Replacement, Hip] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Arthroplasty, Replacement, Knee] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Arthroplasty, Replacement, Shoulder] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Hemiarthroplasty] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #1-#6)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Joint Prosthesis] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Hip Prosthesis] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Knee Prosthesis] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Shoulder Prosthesis] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #8-#11)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((joint* or knee* or shoulder* or hip*) near/5 (surger* or replace* or prosthe* or endoprosthe* or implant* or artificial or arthroplast* or hemiarthroplast*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #7, #12-#13)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Anesthesia] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((anaesthet* or anesthet* or anaesthesia or anesthesia) near/4 (regional* or local* or general or spinal or epidural)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Nerve Block] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((nerve* or neurax* or regional or peripheral*) near/3 block*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((plexus or sciatic* or interscalene or femor* or tibia* or posterior or obturator or fascia iliaca) near/3 block):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(CNB or PNB or FNB or TNB or ONB or LPB or ISBB or FIB or LIA):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((periarticular or local*) near/2 infiltration):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #15-#21)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#14 and #22</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er6appbtab5"><div id="niceng157er6.appb.tab5" class="table"><h3><span class="title">Epistemonikos search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appb.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appb.tab5_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((joint* OR knee* OR shoulder* OR hip*) AND (surger* OR replace* OR prosthe* OR endoprosthe* OR implant* OR artificial OR arthroplast* OR hemiarthroplast*)) AND (((an?esthet* OR an?esthesia) AND (regional* OR local* OR general OR spinal OR epidural)) OR ((nerve* OR neurax* OR regional OR peripheral*) AND block*) OR ((plexus OR sciatic* OR interscalene OR femor* OR tibia* OR posterior OR obturator OR fascia iliaca) AND block) OR (CNB OR PNB OR FNB OR TNB OR ONB OR LPB OR ISBB OR FIB OR LIA) OR ((periarticular OR local*) AND infiltration)) [Filters: protocol=no, classification=systematic-review]</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er6appbtab6"><div id="niceng157er6.appb.tab6" class="table"><h3><span class="label">Table 10</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appb.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appb.tab6_lrgtbl__"><table><thead><tr><th id="hd_h_niceng157er6.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database</th><th id="hd_h_niceng157er6.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dates searched</th><th id="hd_h_niceng157er6.appb.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er6.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline</td><td headers="hd_h_niceng157er6.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2014 – 01 May 2019</td><td headers="hd_h_niceng157er6.appb.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Health economics studies</p>
|
|
</td></tr><tr><td headers="hd_h_niceng157er6.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase</td><td headers="hd_h_niceng157er6.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2014 – 01 May 2019</td><td headers="hd_h_niceng157er6.appb.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Health economics studies</p>
|
|
</td></tr><tr><td headers="hd_h_niceng157er6.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Centre for Research and Dissemination (CRD)</td><td headers="hd_h_niceng157er6.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HTA - Inception – 01 May 2019</p>
|
|
<p>NHSEED - Inception to March 2015</p>
|
|
</td><td headers="hd_h_niceng157er6.appb.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er6appbtab7"><div id="niceng157er6.appb.tab7" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appb.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appb.tab7_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">arthroplasty/ or arthroplasty, replacement/ or arthroplasty, replacement, hip/ or arthroplasty, replacement, knee/ or arthroplasty, replacement, shoulder/ or hemiarthroplasty/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">joint prosthesis/ or hip prosthesis/ or knee prosthesis/ or shoulder prosthesis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((joint* or knee* or shoulder* or hip*) adj5 (surger* or replace* or prosthe* or endoprosthe* or implant* or artificial or arthroplast* or hemiarthroplast*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-3</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/5-12</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13 not 14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/15-21</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 not 22</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 23 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Value of life/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Costs and Cost Analysis”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Hospital/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Medical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Pharmaceutical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Fees and Charges”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Budgets/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/25-40</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24 and 41</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er6appbtab8"><div id="niceng157er6.appb.tab8" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appb.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appb.tab8_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*arthroplasty/ or *replacement arthroplasty/ or *hip replacement/ or *knee replacement/ or *shoulder replacement/ or *hemiarthroplasty/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*joint prosthesis/ or *hip prosthesis/ or *knee prosthesis/ or *shoulder prosthesis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((joint* or knee* or shoulder* or hip*) adj5 (surger* or replace* or prosthe* or endoprosthe* or implant* or artificial or arthroplast* or hemiarthroplast*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-3</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/5-9</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 not 11</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/12-19</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 not 20</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 21 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">health economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp economic evaluation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp health care cost/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp fee/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">funding/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/23-35</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22 and 36</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er6appbtab9"><div id="niceng157er6.appb.tab9" class="table"><h3><span class="title">NHS EED and HTA (CRD) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appb.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appb.tab9_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR arthroplasty</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR arthroplasty, replacement</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR arthroplasty, replacement, hip</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR arthroplasty, replacement, knee</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR arthroplasty, replacement, shoulder</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR hemiarthroplasty</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR joint prosthesis</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR hip prosthesis</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR knee prosthesis</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR shoulder prosthesis</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((joint* or knee* or shoulder* or hip*) adj5 (surger* or replace* or prosthe* or endoprosthe* or implant* or artificial or arthroplast* or hemiarthroplast*)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11) IN NHSEED</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11) IN HTA</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobniceng157er6appcfig1"><div id="niceng157er6.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Flow%20chart%20of%20clinical%20study%20selection%20for%20the%20review%20of%20Anaesthesia%20for%20elective%20shoulder%20joint%20replacement.&p=BOOKS&id=561389_niceng157er6appcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561389/bin/niceng157er6appcf1.jpg" alt="Figure 1. Flow chart of clinical study selection for the review of Anaesthesia for elective shoulder joint replacement." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Flow chart of clinical study selection for the review of Anaesthesia for elective shoulder joint replacement</span></h3></div></article><article data-type="fig" id="figobniceng157er6appefig1"><div id="niceng157er6.appe.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Postoperative%20pain.&p=BOOKS&id=561389_niceng157er6appef1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561389/bin/niceng157er6appef1.jpg" alt="Figure 2. Postoperative pain." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Postoperative pain</span></h3></div></article><article data-type="fig" id="figobniceng157er6appefig2"><div id="niceng157er6.appe.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%203.%20Thromboembolic%20complications.&p=BOOKS&id=561389_niceng157er6appef2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561389/bin/niceng157er6appef2.jpg" alt="Figure 3. Thromboembolic complications." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 3</span><span class="title">Thromboembolic complications</span></h3></div></article><article data-type="fig" id="figobniceng157er6appefig3"><div id="niceng157er6.appe.fig3" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%204.%20Phrenic%20nerve%20palsy.&p=BOOKS&id=561389_niceng157er6appef3.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561389/bin/niceng157er6appef3.jpg" alt="Figure 4. Phrenic nerve palsy." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 4</span><span class="title">Phrenic nerve palsy</span></h3></div></article><article data-type="fig" id="figobniceng157er6appefig4"><div id="niceng157er6.appe.fig4" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%205.%20Postoperative%20use%20of%20analgesia.&p=BOOKS&id=561389_niceng157er6appef4.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561389/bin/niceng157er6appef4.jpg" alt="Figure 5. Postoperative use of analgesia." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 5</span><span class="title">Postoperative use of analgesia</span></h3></div></article><article data-type="fig" id="figobniceng157er6appefig5"><div id="niceng157er6.appe.fig5" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%206.%20Length%20of%20stay.&p=BOOKS&id=561389_niceng157er6appef5.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561389/bin/niceng157er6appef5.jpg" alt="Figure 6. Length of stay." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 6</span><span class="title">Length of stay</span></h3></div></article><article data-type="fig" id="figobniceng157er6appefig6"><div id="niceng157er6.appe.fig6" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%207.%20Readmission%20within%2090%20days.&p=BOOKS&id=561389_niceng157er6appef6.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561389/bin/niceng157er6appef6.jpg" alt="Figure 7. Readmission within 90 days." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 7</span><span class="title">Readmission within 90 days</span></h3></div></article><article data-type="fig" id="figobniceng157er6appefig7"><div id="niceng157er6.appe.fig7" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%208.%20Gastrointestinal%20complications.&p=BOOKS&id=561389_niceng157er6appef7.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561389/bin/niceng157er6appef7.jpg" alt="Figure 8. Gastrointestinal complications." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 8</span><span class="title">Gastrointestinal complications</span></h3></div></article><article data-type="fig" id="figobniceng157er6appefig8"><div id="niceng157er6.appe.fig8" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%209.%20Thromboembolic%20complications.&p=BOOKS&id=561389_niceng157er6appef8.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561389/bin/niceng157er6appef8.jpg" alt="Figure 9. Thromboembolic complications." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 9</span><span class="title">Thromboembolic complications</span></h3></div></article><article data-type="fig" id="figobniceng157er6appefig9"><div id="niceng157er6.appe.fig9" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2010.%20Length%20of%20stay.&p=BOOKS&id=561389_niceng157er6appef9.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561389/bin/niceng157er6appef9.jpg" alt="Figure 10. Length of stay." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 10</span><span class="title">Length of stay</span></h3></div></article><article data-type="fig" id="figobniceng157er6appefig10"><div id="niceng157er6.appe.fig10" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2011.%20Intensive%20care%20unit%20admission.&p=BOOKS&id=561389_niceng157er6appef10.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561389/bin/niceng157er6appef10.jpg" alt="Figure 11. Intensive care unit admission." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 11</span><span class="title">Intensive care unit admission</span></h3></div></article><article data-type="fig" id="figobniceng157er6appefig11"><div id="niceng157er6.appe.fig11" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2012.%20Pulmonary%20complications.&p=BOOKS&id=561389_niceng157er6appef11.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561389/bin/niceng157er6appef11.jpg" alt="Figure 12. Pulmonary complications." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 12</span><span class="title">Pulmonary complications</span></h3></div></article><article data-type="fig" id="figobniceng157er6appefig12"><div id="niceng157er6.appe.fig12" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2013.%20Increased%20length%20of%20stay.&p=BOOKS&id=561389_niceng157er6appef12.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561389/bin/niceng157er6appef12.jpg" alt="Figure 13. Increased length of stay." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 13</span><span class="title">Increased length of stay</span></h3></div></article><article data-type="table-wrap" id="figobniceng157er6appftab1"><div id="niceng157er6.appf.tab1" class="table"><h3><span class="label">Table 11</span><span class="title">RCT evidence profile: General anaesthesia with LIA versus general anaesthesia with regional anaesthesia</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appf.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appf.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng157er6.appf.tab1_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_niceng157er6.appf.tab1_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_niceng157er6.appf.tab1_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_niceng157er6.appf.tab1_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng157er6.appf.tab1_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_niceng157er6.appf.tab1_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_niceng157er6.appf.tab1_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_1" id="hd_h_niceng157er6.appf.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_1" id="hd_h_niceng157er6.appf.tab1_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_1" id="hd_h_niceng157er6.appf.tab1_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_1" id="hd_h_niceng157er6.appf.tab1_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_1" id="hd_h_niceng157er6.appf.tab1_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_1" id="hd_h_niceng157er6.appf.tab1_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_1" id="hd_h_niceng157er6.appf.tab1_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_2" id="hd_h_niceng157er6.appf.tab1_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">General anaesthesia with LIA</th><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_2" id="hd_h_niceng157er6.appf.tab1_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">General anaesthesia with regional anaesthesia</th><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_3" id="hd_h_niceng157er6.appf.tab1_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_3" id="hd_h_niceng157er6.appf.tab1_1_1_2_11" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_1 hd_h_niceng157er6.appf.tab1_1_1_2_2 hd_h_niceng157er6.appf.tab1_1_1_2_3 hd_h_niceng157er6.appf.tab1_1_1_2_4 hd_h_niceng157er6.appf.tab1_1_1_2_5 hd_h_niceng157er6.appf.tab1_1_1_2_6 hd_h_niceng157er6.appf.tab1_1_1_2_7 hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_8 hd_h_niceng157er6.appf.tab1_1_1_2_9 hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_10 hd_h_niceng157er6.appf.tab1_1_1_2_11 hd_h_niceng157er6.appf.tab1_1_1_1_4 hd_h_niceng157er6.appf.tab1_1_1_1_5" id="hd_b_niceng157er6.appf.tab1_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Postoperative pain (measured with: Mean VAS; range of scores: 0-10; Better indicated by lower values)</th></tr><tr><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_1 hd_b_niceng157er6.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_2 hd_b_niceng157er6.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_3 hd_b_niceng157er6.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>1</sup></td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_4 hd_b_niceng157er6.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_5 hd_b_niceng157er6.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_6 hd_b_niceng157er6.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>3</sup></td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_7 hd_b_niceng157er6.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_8 hd_b_niceng157er6.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">104</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_9 hd_b_niceng157er6.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">109</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_10 hd_b_niceng157er6.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_11 hd_b_niceng157er6.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 1.35 higher (0.37 to 2.32 higher)</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_4 hd_b_niceng157er6.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁◯◯◯</p>
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<p>VERY LOW</p>
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|
</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_5 hd_b_niceng157er6.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_1 hd_h_niceng157er6.appf.tab1_1_1_2_2 hd_h_niceng157er6.appf.tab1_1_1_2_3 hd_h_niceng157er6.appf.tab1_1_1_2_4 hd_h_niceng157er6.appf.tab1_1_1_2_5 hd_h_niceng157er6.appf.tab1_1_1_2_6 hd_h_niceng157er6.appf.tab1_1_1_2_7 hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_8 hd_h_niceng157er6.appf.tab1_1_1_2_9 hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_10 hd_h_niceng157er6.appf.tab1_1_1_2_11 hd_h_niceng157er6.appf.tab1_1_1_1_4 hd_h_niceng157er6.appf.tab1_1_1_1_5" id="hd_b_niceng157er6.appf.tab1_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Thromboembolic complications (assessed with: Pulmonary embolism)</th></tr><tr><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_1 hd_b_niceng157er6.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_2 hd_b_niceng157er6.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_3 hd_b_niceng157er6.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_4 hd_b_niceng157er6.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_5 hd_b_niceng157er6.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_6 hd_b_niceng157er6.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>3</sup></td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_7 hd_b_niceng157er6.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_8 hd_b_niceng157er6.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>0/33</p>
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<p>(0%)</p>
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</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_9 hd_b_niceng157er6.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>1/32</p>
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|
<p>(3.1%)</p>
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</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_10 hd_b_niceng157er6.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">OR 0.13 (0 to 6.61)</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_11 hd_b_niceng157er6.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">27 fewer per 1000 (from 31 fewer to 145 more)</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_4 hd_b_niceng157er6.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁◯◯◯</p>
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<p>VERY LOW</p>
|
|
</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_5 hd_b_niceng157er6.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_1 hd_h_niceng157er6.appf.tab1_1_1_2_2 hd_h_niceng157er6.appf.tab1_1_1_2_3 hd_h_niceng157er6.appf.tab1_1_1_2_4 hd_h_niceng157er6.appf.tab1_1_1_2_5 hd_h_niceng157er6.appf.tab1_1_1_2_6 hd_h_niceng157er6.appf.tab1_1_1_2_7 hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_8 hd_h_niceng157er6.appf.tab1_1_1_2_9 hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_10 hd_h_niceng157er6.appf.tab1_1_1_2_11 hd_h_niceng157er6.appf.tab1_1_1_1_4 hd_h_niceng157er6.appf.tab1_1_1_1_5" id="hd_b_niceng157er6.appf.tab1_1_1_5_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Phrenic nerve palsy (assessed with: Suspected or requiring readmission)</th></tr><tr><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_1 hd_b_niceng157er6.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_2 hd_b_niceng157er6.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_3 hd_b_niceng157er6.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_4 hd_b_niceng157er6.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_5 hd_b_niceng157er6.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_6 hd_b_niceng157er6.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>3</sup></td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_7 hd_b_niceng157er6.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_8 hd_b_niceng157er6.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>0/59</p>
|
|
<p>(0%)</p>
|
|
</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_9 hd_b_niceng157er6.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>2/63</p>
|
|
<p>(3.2%)</p>
|
|
</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_10 hd_b_niceng157er6.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">OR 0.14 (0.01 to 2.32)</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_11 hd_b_niceng157er6.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">27 fewer per 1000 (from 31 fewer to 39 more)</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_4 hd_b_niceng157er6.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁◯◯◯</p>
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<p>VERY LOW</p>
|
|
</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_5 hd_b_niceng157er6.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_1 hd_h_niceng157er6.appf.tab1_1_1_2_2 hd_h_niceng157er6.appf.tab1_1_1_2_3 hd_h_niceng157er6.appf.tab1_1_1_2_4 hd_h_niceng157er6.appf.tab1_1_1_2_5 hd_h_niceng157er6.appf.tab1_1_1_2_6 hd_h_niceng157er6.appf.tab1_1_1_2_7 hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_8 hd_h_niceng157er6.appf.tab1_1_1_2_9 hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_10 hd_h_niceng157er6.appf.tab1_1_1_2_11 hd_h_niceng157er6.appf.tab1_1_1_1_4 hd_h_niceng157er6.appf.tab1_1_1_1_5" id="hd_b_niceng157er6.appf.tab1_1_1_7_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Postoperative use of analgesia (measured with: Narcotic consumption; Better indicated by lower values)</th></tr><tr><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_1 hd_b_niceng157er6.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_2 hd_b_niceng157er6.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_3 hd_b_niceng157er6.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_4 hd_b_niceng157er6.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_5 hd_b_niceng157er6.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_6 hd_b_niceng157er6.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>3</sup></td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_7 hd_b_niceng157er6.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_8 hd_b_niceng157er6.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">104</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_9 hd_b_niceng157er6.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">109</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_10 hd_b_niceng157er6.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_11 hd_b_niceng157er6.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 3.33 lower (9.04 lower to 2.74 higher)</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_4 hd_b_niceng157er6.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁◯◯◯</p>
|
|
<p>VERY LOW</p>
|
|
</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_5 hd_b_niceng157er6.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_1 hd_h_niceng157er6.appf.tab1_1_1_2_2 hd_h_niceng157er6.appf.tab1_1_1_2_3 hd_h_niceng157er6.appf.tab1_1_1_2_4 hd_h_niceng157er6.appf.tab1_1_1_2_5 hd_h_niceng157er6.appf.tab1_1_1_2_6 hd_h_niceng157er6.appf.tab1_1_1_2_7 hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_8 hd_h_niceng157er6.appf.tab1_1_1_2_9 hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_10 hd_h_niceng157er6.appf.tab1_1_1_2_11 hd_h_niceng157er6.appf.tab1_1_1_1_4 hd_h_niceng157er6.appf.tab1_1_1_1_5" id="hd_b_niceng157er6.appf.tab1_1_1_9_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Postoperative use of analgesia<sup>4</sup> (assessed with: Median opioid consumption)</th></tr><tr><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_1 hd_b_niceng157er6.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_2 hd_b_niceng157er6.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_3 hd_b_niceng157er6.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>1</sup></td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_4 hd_b_niceng157er6.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_5 hd_b_niceng157er6.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_6 hd_b_niceng157er6.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_7 hd_b_niceng157er6.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_8 hd_b_niceng157er6.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Median (IQR) in mg</p>
|
|
<p>General anaesthesia with LIA: 95 (170-150)</p>
|
|
<p>General anaesthesia with non-ISB nerve block: 40 (8-76)</p>
|
|
</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_9 hd_b_niceng157er6.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Not estimable</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_10 hd_b_niceng157er6.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Not estimable</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_11 hd_b_niceng157er6.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Deemed to be at very high risk of bias. Imprecision unclear.</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_4 hd_b_niceng157er6.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Unable to assess</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_5 hd_b_niceng157er6.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_1 hd_h_niceng157er6.appf.tab1_1_1_2_2 hd_h_niceng157er6.appf.tab1_1_1_2_3 hd_h_niceng157er6.appf.tab1_1_1_2_4 hd_h_niceng157er6.appf.tab1_1_1_2_5 hd_h_niceng157er6.appf.tab1_1_1_2_6 hd_h_niceng157er6.appf.tab1_1_1_2_7 hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_8 hd_h_niceng157er6.appf.tab1_1_1_2_9 hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_10 hd_h_niceng157er6.appf.tab1_1_1_2_11 hd_h_niceng157er6.appf.tab1_1_1_1_4 hd_h_niceng157er6.appf.tab1_1_1_1_5" id="hd_b_niceng157er6.appf.tab1_1_1_11_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Length of stay (Better indicated by lower values)</th></tr><tr><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_1 hd_b_niceng157er6.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_2 hd_b_niceng157er6.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_3 hd_b_niceng157er6.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_4 hd_b_niceng157er6.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_5 hd_b_niceng157er6.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_6 hd_b_niceng157er6.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision<sup>3</sup></td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_7 hd_b_niceng157er6.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_8 hd_b_niceng157er6.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">104</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_9 hd_b_niceng157er6.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">109</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_10 hd_b_niceng157er6.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_11 hd_b_niceng157er6.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.17 lower (0.37 lower to 0.03 higher)</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_4 hd_b_niceng157er6.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁⨁◯</p>
|
|
<p>MODERATE</p>
|
|
</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_5 hd_b_niceng157er6.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_1 hd_h_niceng157er6.appf.tab1_1_1_2_2 hd_h_niceng157er6.appf.tab1_1_1_2_3 hd_h_niceng157er6.appf.tab1_1_1_2_4 hd_h_niceng157er6.appf.tab1_1_1_2_5 hd_h_niceng157er6.appf.tab1_1_1_2_6 hd_h_niceng157er6.appf.tab1_1_1_2_7 hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_8 hd_h_niceng157er6.appf.tab1_1_1_2_9 hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_10 hd_h_niceng157er6.appf.tab1_1_1_2_11 hd_h_niceng157er6.appf.tab1_1_1_1_4 hd_h_niceng157er6.appf.tab1_1_1_1_5" id="hd_b_niceng157er6.appf.tab1_1_1_13_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Median length of stay<sup>4</sup></th></tr><tr><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_1 hd_b_niceng157er6.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_2 hd_b_niceng157er6.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_3 hd_b_niceng157er6.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>1</sup></td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_4 hd_b_niceng157er6.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_5 hd_b_niceng157er6.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_6 hd_b_niceng157er6.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_1 hd_h_niceng157er6.appf.tab1_1_1_2_7 hd_b_niceng157er6.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_8 hd_b_niceng157er6.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Median (range) in days</p>
|
|
<p>General anaesthesia with LIA: 2 (1-6)</p>
|
|
<p>General anaesthesia with non-ISB nerve block: 2 (1-3)</p>
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|
</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_2 hd_h_niceng157er6.appf.tab1_1_1_2_9 hd_b_niceng157er6.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Not estimable</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_10 hd_b_niceng157er6.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Not estimable</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_3 hd_h_niceng157er6.appf.tab1_1_1_2_11 hd_b_niceng157er6.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Deemed to be at very high risk of bias. Imprecision unclear.</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_4 hd_b_niceng157er6.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Unable to assess</td><td headers="hd_h_niceng157er6.appf.tab1_1_1_1_5 hd_b_niceng157er6.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng157er6.appf.tab1_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng157er6.appf.tab1_2"><p class="no_margin">Downgraded by 1 or 2 increments because the point estimate varies widely across studies, unexplained by subgroup analysis. Random effects model used.</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng157er6.appf.tab1_3"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs.</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="niceng157er6.appf.tab1_4"><p class="no_margin">Outcome reported as a median and it was not possible to assess the precision or to calculate the absolute effect and therefore grade the overall quality.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng157er6appftab2"><div id="niceng157er6.appf.tab2" class="table"><h3><span class="label">Table 12</span><span class="title">NRS evidence profile: Regional anaesthesia versus general anaesthesia with or without regional blockade</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appf.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appf.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng157er6.appf.tab2_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_niceng157er6.appf.tab2_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_niceng157er6.appf.tab2_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_niceng157er6.appf.tab2_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng157er6.appf.tab2_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_niceng157er6.appf.tab2_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_niceng157er6.appf.tab2_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_niceng157er6.appf.tab2_1_1_1_1" id="hd_h_niceng157er6.appf.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_niceng157er6.appf.tab2_1_1_1_1" id="hd_h_niceng157er6.appf.tab2_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_niceng157er6.appf.tab2_1_1_1_1" id="hd_h_niceng157er6.appf.tab2_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_niceng157er6.appf.tab2_1_1_1_1" id="hd_h_niceng157er6.appf.tab2_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_niceng157er6.appf.tab2_1_1_1_1" id="hd_h_niceng157er6.appf.tab2_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_niceng157er6.appf.tab2_1_1_1_1" id="hd_h_niceng157er6.appf.tab2_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_niceng157er6.appf.tab2_1_1_1_1" id="hd_h_niceng157er6.appf.tab2_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_niceng157er6.appf.tab2_1_1_1_2" id="hd_h_niceng157er6.appf.tab2_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Regional anaesthesia</th><th headers="hd_h_niceng157er6.appf.tab2_1_1_1_2" id="hd_h_niceng157er6.appf.tab2_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">General anaesthesia with or without regional blockade</th><th headers="hd_h_niceng157er6.appf.tab2_1_1_1_3" id="hd_h_niceng157er6.appf.tab2_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_niceng157er6.appf.tab2_1_1_1_3" id="hd_h_niceng157er6.appf.tab2_1_1_2_11" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_1 hd_h_niceng157er6.appf.tab2_1_1_2_2 hd_h_niceng157er6.appf.tab2_1_1_2_3 hd_h_niceng157er6.appf.tab2_1_1_2_4 hd_h_niceng157er6.appf.tab2_1_1_2_5 hd_h_niceng157er6.appf.tab2_1_1_2_6 hd_h_niceng157er6.appf.tab2_1_1_2_7 hd_h_niceng157er6.appf.tab2_1_1_1_2 hd_h_niceng157er6.appf.tab2_1_1_2_8 hd_h_niceng157er6.appf.tab2_1_1_2_9 hd_h_niceng157er6.appf.tab2_1_1_1_3 hd_h_niceng157er6.appf.tab2_1_1_2_10 hd_h_niceng157er6.appf.tab2_1_1_2_11 hd_h_niceng157er6.appf.tab2_1_1_1_4 hd_h_niceng157er6.appf.tab2_1_1_1_5" id="hd_b_niceng157er6.appf.tab2_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Readmission</th></tr><tr><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_1 hd_b_niceng157er6.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_2 hd_b_niceng157er6.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_3 hd_b_niceng157er6.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_4 hd_b_niceng157er6.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_5 hd_b_niceng157er6.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_6 hd_b_niceng157er6.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_7 hd_b_niceng157er6.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_2 hd_h_niceng157er6.appf.tab2_1_1_2_8 hd_b_niceng157er6.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>38/912</p>
|
|
<p>(4.2%)</p>
|
|
</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_2 hd_h_niceng157er6.appf.tab2_1_1_2_9 hd_b_niceng157er6.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>59/912</p>
|
|
<p>(6.5%)</p>
|
|
</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_3 hd_h_niceng157er6.appf.tab2_1_1_2_10 hd_b_niceng157er6.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.64 (0.43 to 0.96)</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_3 hd_h_niceng157er6.appf.tab2_1_1_2_11 hd_b_niceng157er6.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">23 fewer per 1000 (from 3 fewer to 37 fewer)</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_4 hd_b_niceng157er6.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁◯◯◯</p>
|
|
<p>VERY LOW</p>
|
|
</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_5 hd_b_niceng157er6.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_1 hd_h_niceng157er6.appf.tab2_1_1_2_2 hd_h_niceng157er6.appf.tab2_1_1_2_3 hd_h_niceng157er6.appf.tab2_1_1_2_4 hd_h_niceng157er6.appf.tab2_1_1_2_5 hd_h_niceng157er6.appf.tab2_1_1_2_6 hd_h_niceng157er6.appf.tab2_1_1_2_7 hd_h_niceng157er6.appf.tab2_1_1_1_2 hd_h_niceng157er6.appf.tab2_1_1_2_8 hd_h_niceng157er6.appf.tab2_1_1_2_9 hd_h_niceng157er6.appf.tab2_1_1_1_3 hd_h_niceng157er6.appf.tab2_1_1_2_10 hd_h_niceng157er6.appf.tab2_1_1_2_11 hd_h_niceng157er6.appf.tab2_1_1_1_4 hd_h_niceng157er6.appf.tab2_1_1_1_5" id="hd_b_niceng157er6.appf.tab2_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Thromboembolic complications (assessed with: DVT or PE)</th></tr><tr><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_1 hd_b_niceng157er6.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_2 hd_b_niceng157er6.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_3 hd_b_niceng157er6.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_4 hd_b_niceng157er6.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_5 hd_b_niceng157er6.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_6 hd_b_niceng157er6.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>2</sup></td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_7 hd_b_niceng157er6.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_2 hd_h_niceng157er6.appf.tab2_1_1_2_8 hd_b_niceng157er6.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>2/912</p>
|
|
<p>(0.22%)</p>
|
|
</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_2 hd_h_niceng157er6.appf.tab2_1_1_2_9 hd_b_niceng157er6.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>1/912</p>
|
|
<p>(0.11%)</p>
|
|
</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_3 hd_h_niceng157er6.appf.tab2_1_1_2_10 hd_b_niceng157er6.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 2 (0.18 to 22.02)</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_3 hd_h_niceng157er6.appf.tab2_1_1_2_11 hd_b_niceng157er6.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1 more per 1000 (from 1 fewer to 23 more)</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_4 hd_b_niceng157er6.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁◯◯◯</p>
|
|
<p>VERY LOW</p>
|
|
</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_5 hd_b_niceng157er6.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_1 hd_h_niceng157er6.appf.tab2_1_1_2_2 hd_h_niceng157er6.appf.tab2_1_1_2_3 hd_h_niceng157er6.appf.tab2_1_1_2_4 hd_h_niceng157er6.appf.tab2_1_1_2_5 hd_h_niceng157er6.appf.tab2_1_1_2_6 hd_h_niceng157er6.appf.tab2_1_1_2_7 hd_h_niceng157er6.appf.tab2_1_1_1_2 hd_h_niceng157er6.appf.tab2_1_1_2_8 hd_h_niceng157er6.appf.tab2_1_1_2_9 hd_h_niceng157er6.appf.tab2_1_1_1_3 hd_h_niceng157er6.appf.tab2_1_1_2_10 hd_h_niceng157er6.appf.tab2_1_1_2_11 hd_h_niceng157er6.appf.tab2_1_1_1_4 hd_h_niceng157er6.appf.tab2_1_1_1_5" id="hd_b_niceng157er6.appf.tab2_1_1_5_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Length of stay (Better indicated by lower values)</th></tr><tr><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_1 hd_b_niceng157er6.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_2 hd_b_niceng157er6.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_3 hd_b_niceng157er6.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_4 hd_b_niceng157er6.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_5 hd_b_niceng157er6.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_6 hd_b_niceng157er6.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_7 hd_b_niceng157er6.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_2 hd_h_niceng157er6.appf.tab2_1_1_2_8 hd_b_niceng157er6.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">912</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_2 hd_h_niceng157er6.appf.tab2_1_1_2_9 hd_b_niceng157er6.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">912</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_3 hd_h_niceng157er6.appf.tab2_1_1_2_10 hd_b_niceng157er6.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_3 hd_h_niceng157er6.appf.tab2_1_1_2_11 hd_b_niceng157er6.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.3 higher (0.2 to 0.4 higher)</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_4 hd_b_niceng157er6.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁◯◯◯</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_5 hd_b_niceng157er6.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_1 hd_h_niceng157er6.appf.tab2_1_1_2_2 hd_h_niceng157er6.appf.tab2_1_1_2_3 hd_h_niceng157er6.appf.tab2_1_1_2_4 hd_h_niceng157er6.appf.tab2_1_1_2_5 hd_h_niceng157er6.appf.tab2_1_1_2_6 hd_h_niceng157er6.appf.tab2_1_1_2_7 hd_h_niceng157er6.appf.tab2_1_1_1_2 hd_h_niceng157er6.appf.tab2_1_1_2_8 hd_h_niceng157er6.appf.tab2_1_1_2_9 hd_h_niceng157er6.appf.tab2_1_1_1_3 hd_h_niceng157er6.appf.tab2_1_1_2_10 hd_h_niceng157er6.appf.tab2_1_1_2_11 hd_h_niceng157er6.appf.tab2_1_1_1_4 hd_h_niceng157er6.appf.tab2_1_1_1_5" id="hd_b_niceng157er6.appf.tab2_1_1_7_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Nausea (assessed with: gastrointestinal complications)</th></tr><tr><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_1 hd_b_niceng157er6.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_2 hd_b_niceng157er6.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_3 hd_b_niceng157er6.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_4 hd_b_niceng157er6.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_5 hd_b_niceng157er6.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_6 hd_b_niceng157er6.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_1 hd_h_niceng157er6.appf.tab2_1_1_2_7 hd_b_niceng157er6.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_2 hd_h_niceng157er6.appf.tab2_1_1_2_8 hd_b_niceng157er6.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>0/912</p>
|
|
<p>(0%)</p>
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|
</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_2 hd_h_niceng157er6.appf.tab2_1_1_2_9 hd_b_niceng157er6.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>0/912</p>
|
|
<p>(0%)</p>
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|
</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_3 hd_h_niceng157er6.appf.tab2_1_1_2_10 hd_b_niceng157er6.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RD 0 (0 to 0)</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_3 hd_h_niceng157er6.appf.tab2_1_1_2_11 hd_b_niceng157er6.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0 fewer per 1000 (from 0 more to 0 more)<sup>3</sup></td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_4 hd_b_niceng157er6.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁◯◯◯</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_niceng157er6.appf.tab2_1_1_1_5 hd_b_niceng157er6.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng157er6.appf.tab2_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng157er6.appf.tab2_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs.</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng157er6.appf.tab2_3"><p class="no_margin">Absolute effect calculated using the risk difference. RD: 0 (0-0)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng157er6appftab3"><div id="niceng157er6.appf.tab3" class="table"><h3><span class="label">Table 13</span><span class="title">NRS evidence profile: General anaesthesia with peripheral nerve block versus general anaesthesia</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appf.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appf.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng157er6.appf.tab3_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_niceng157er6.appf.tab3_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_niceng157er6.appf.tab3_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_niceng157er6.appf.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng157er6.appf.tab3_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_niceng157er6.appf.tab3_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_niceng157er6.appf.tab3_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_niceng157er6.appf.tab3_1_1_1_1" id="hd_h_niceng157er6.appf.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_niceng157er6.appf.tab3_1_1_1_1" id="hd_h_niceng157er6.appf.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_niceng157er6.appf.tab3_1_1_1_1" id="hd_h_niceng157er6.appf.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_niceng157er6.appf.tab3_1_1_1_1" id="hd_h_niceng157er6.appf.tab3_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_niceng157er6.appf.tab3_1_1_1_1" id="hd_h_niceng157er6.appf.tab3_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_niceng157er6.appf.tab3_1_1_1_1" id="hd_h_niceng157er6.appf.tab3_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_niceng157er6.appf.tab3_1_1_1_1" id="hd_h_niceng157er6.appf.tab3_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_niceng157er6.appf.tab3_1_1_1_2" id="hd_h_niceng157er6.appf.tab3_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">General anaesthesia with peripheral nerve block</th><th headers="hd_h_niceng157er6.appf.tab3_1_1_1_2" id="hd_h_niceng157er6.appf.tab3_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">General anaesthesia</th><th headers="hd_h_niceng157er6.appf.tab3_1_1_1_3" id="hd_h_niceng157er6.appf.tab3_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_niceng157er6.appf.tab3_1_1_1_3" id="hd_h_niceng157er6.appf.tab3_1_1_2_11" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_1 hd_h_niceng157er6.appf.tab3_1_1_2_2 hd_h_niceng157er6.appf.tab3_1_1_2_3 hd_h_niceng157er6.appf.tab3_1_1_2_4 hd_h_niceng157er6.appf.tab3_1_1_2_5 hd_h_niceng157er6.appf.tab3_1_1_2_6 hd_h_niceng157er6.appf.tab3_1_1_2_7 hd_h_niceng157er6.appf.tab3_1_1_1_2 hd_h_niceng157er6.appf.tab3_1_1_2_8 hd_h_niceng157er6.appf.tab3_1_1_2_9 hd_h_niceng157er6.appf.tab3_1_1_1_3 hd_h_niceng157er6.appf.tab3_1_1_2_10 hd_h_niceng157er6.appf.tab3_1_1_2_11 hd_h_niceng157er6.appf.tab3_1_1_1_4 hd_h_niceng157er6.appf.tab3_1_1_1_5" id="hd_b_niceng157er6.appf.tab3_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Intensive care unit admission</th></tr><tr><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_1 hd_b_niceng157er6.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_2 hd_b_niceng157er6.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_3 hd_b_niceng157er6.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_4 hd_b_niceng157er6.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_5 hd_b_niceng157er6.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_6 hd_b_niceng157er6.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_7 hd_b_niceng157er6.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_2 hd_h_niceng157er6.appf.tab3_1_1_2_8 hd_b_niceng157er6.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Not estimable</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_2 hd_h_niceng157er6.appf.tab3_1_1_2_9 hd_b_niceng157er6.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Not estimable</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_3 hd_h_niceng157er6.appf.tab3_1_1_2_10 hd_b_niceng157er6.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">OR 1.16 (0.93 to 1.45)</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_3 hd_h_niceng157er6.appf.tab3_1_1_2_11 hd_b_niceng157er6.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Not estimable</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_4 hd_b_niceng157er6.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>⨁◯◯◯</p>
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<p>VERY LOW</p>
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|
</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_5 hd_b_niceng157er6.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_1 hd_h_niceng157er6.appf.tab3_1_1_2_2 hd_h_niceng157er6.appf.tab3_1_1_2_3 hd_h_niceng157er6.appf.tab3_1_1_2_4 hd_h_niceng157er6.appf.tab3_1_1_2_5 hd_h_niceng157er6.appf.tab3_1_1_2_6 hd_h_niceng157er6.appf.tab3_1_1_2_7 hd_h_niceng157er6.appf.tab3_1_1_1_2 hd_h_niceng157er6.appf.tab3_1_1_2_8 hd_h_niceng157er6.appf.tab3_1_1_2_9 hd_h_niceng157er6.appf.tab3_1_1_1_3 hd_h_niceng157er6.appf.tab3_1_1_2_10 hd_h_niceng157er6.appf.tab3_1_1_2_11 hd_h_niceng157er6.appf.tab3_1_1_1_4 hd_h_niceng157er6.appf.tab3_1_1_1_5" id="hd_b_niceng157er6.appf.tab3_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Pulmonary complications (assessed with: pulmonary embolism, pneumonia, and pulmonary compromise)</th></tr><tr><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_1 hd_b_niceng157er6.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_2 hd_b_niceng157er6.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_3 hd_b_niceng157er6.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_4 hd_b_niceng157er6.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_5 hd_b_niceng157er6.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_6 hd_b_niceng157er6.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_7 hd_b_niceng157er6.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_2 hd_h_niceng157er6.appf.tab3_1_1_2_8 hd_b_niceng157er6.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Not estimable</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_2 hd_h_niceng157er6.appf.tab3_1_1_2_9 hd_b_niceng157er6.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Not estimable</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_3 hd_h_niceng157er6.appf.tab3_1_1_2_10 hd_b_niceng157er6.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">OR 0 (0.66 to 1.15)</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_3 hd_h_niceng157er6.appf.tab3_1_1_2_11 hd_b_niceng157er6.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Not estimable</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_4 hd_b_niceng157er6.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁◯◯◯</p>
|
|
<p>VERY LOW</p>
|
|
</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_5 hd_b_niceng157er6.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_1 hd_h_niceng157er6.appf.tab3_1_1_2_2 hd_h_niceng157er6.appf.tab3_1_1_2_3 hd_h_niceng157er6.appf.tab3_1_1_2_4 hd_h_niceng157er6.appf.tab3_1_1_2_5 hd_h_niceng157er6.appf.tab3_1_1_2_6 hd_h_niceng157er6.appf.tab3_1_1_2_7 hd_h_niceng157er6.appf.tab3_1_1_1_2 hd_h_niceng157er6.appf.tab3_1_1_2_8 hd_h_niceng157er6.appf.tab3_1_1_2_9 hd_h_niceng157er6.appf.tab3_1_1_1_3 hd_h_niceng157er6.appf.tab3_1_1_2_10 hd_h_niceng157er6.appf.tab3_1_1_2_11 hd_h_niceng157er6.appf.tab3_1_1_1_4 hd_h_niceng157er6.appf.tab3_1_1_1_5" id="hd_b_niceng157er6.appf.tab3_1_1_5_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Increased length of stay</th></tr><tr><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_1 hd_b_niceng157er6.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_2 hd_b_niceng157er6.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_3 hd_b_niceng157er6.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_4 hd_b_niceng157er6.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_5 hd_b_niceng157er6.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_6 hd_b_niceng157er6.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_1 hd_h_niceng157er6.appf.tab3_1_1_2_7 hd_b_niceng157er6.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_2 hd_h_niceng157er6.appf.tab3_1_1_2_8 hd_b_niceng157er6.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">3665</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_2 hd_h_niceng157er6.appf.tab3_1_1_2_9 hd_b_niceng157er6.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">13892</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_3 hd_h_niceng157er6.appf.tab3_1_1_2_10 hd_b_niceng157er6.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">OR 0.89 (0.82 to 0.97)</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_3 hd_h_niceng157er6.appf.tab3_1_1_2_11 hd_b_niceng157er6.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Not estimable</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_4 hd_b_niceng157er6.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁◯◯◯</p>
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<p>VERY LOW</p>
|
|
</td><td headers="hd_h_niceng157er6.appf.tab3_1_1_1_5 hd_b_niceng157er6.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng157er6.appf.tab3_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng157er6.appf.tab3_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs.</p></div></dd></dl></dl></div></div></div></article><article data-type="fig" id="figobniceng157er6appgfig1"><div id="niceng157er6.appg.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2014.%20Flow%20chart%20of%20health%20economic%20study%20selection%20for%20the%20guideline.&p=BOOKS&id=561389_niceng157er6appgf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561389/bin/niceng157er6appgf1.jpg" alt="Figure 14. Flow chart of health economic study selection for the guideline." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 14</span><span class="title">Flow chart of health economic study selection for the guideline</span></h3><div class="caption"><p>a) Non-relevant population, intervention, comparison, design or setting; non-English language</p><p>b) One study was applicable to both Q3.1 and Q3.2</p></div></div></article><article data-type="table-wrap" id="figobniceng157er6appitab1"><div id="niceng157er6.appi.tab1" class="table"><h3><span class="label">Table 14</span><span class="title">UK 2018 cost for the addition of a nerve block to an anaesthetic regimen for primary elective joint replacement when varying administration time and the inclusion of theatre time cost</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appi.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appi.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng157er6.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Extra time in theatre</th><th id="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Resource</th><th id="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Unit cost</th><th id="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Source</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_1" rowspan="12" colspan="1" style="text-align:left;vertical-align:middle;">
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<b>5 min</b>
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</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Biogel</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.07</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Chlorhexidine</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.08</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Vial with Lidocaine 1% 10ml ampoule</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.38</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">BNF</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Vial of 0.5% Levobupivacaine (5mg/ml)</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£3.88</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">BNF</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Syringes (10ml)</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.06</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Filter needle</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.23</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Regional block needle</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£5.78</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Hypodermic needle</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.35</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Cost per consultant anaesthetist (£1.80 per minute)</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£9.00</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">PSSRU 2018</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
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<b>Total cost excluding theatre time</b>
|
|
<sup>
|
|
(a)
|
|
</sup>
|
|
</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">
|
|
<b>£31.83</b>
|
|
</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Cost of theatre time (£20.50 per min)</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£102.50</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">CG124</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>Total cost including theatre time</b>
|
|
<sup>
|
|
(b)
|
|
</sup>
|
|
</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">
|
|
<b>£125.33</b>
|
|
</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_1" rowspan="12" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>10 min</b>
|
|
</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Biogel</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.07</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Chlorhexidine</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.08</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Vial with Lidocaine 1% 10ml ampoule</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.38</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">BNF</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Vial of 0.5% Levobupivacaine (5mg/ml)</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£3.88</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">BNF</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Syringes (10ml)</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.06</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Filter needle</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.23</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Regional block needle</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£5.78</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Hypodermic needle</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.35</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Cost per consultant anaesthetist (£1.80 per minute)</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£18.00</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">PSSRU 2018</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>Total cost excluding theatre time</b>
|
|
<sup>
|
|
(a)
|
|
</sup>
|
|
</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">
|
|
<b>£49.83</b>
|
|
</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Cost of theatre time (£20.50 per min)</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£205.00</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">CG124</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>Total cost including theatre time</b>
|
|
<sup>
|
|
(b)
|
|
</sup>
|
|
</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">
|
|
<b>£236.83</b>
|
|
</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_1" rowspan="12" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>30 min</b>
|
|
</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Biogel</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.07</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Chlorhexidine</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.08</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Vial with Lidocaine 1% 10ml ampoule</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.38</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">BNF</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Vial of 0.5% Levobupivacaine (5mg/ml)</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£3.88</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">BNF</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Syringes (10ml)</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.06</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Filter needle</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£0.23</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Regional block needle</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£5.78</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Hypodermic needle</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£1.35</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Cost per consultant anaesthetist (£1.80 per minute)</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£54.00</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">PSSRU 2018</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>Total cost excluding theatre time</b>
|
|
<sup>
|
|
(a)
|
|
</sup>
|
|
</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">
|
|
<b>£121.83</b>
|
|
</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Cost of theatre time (£20.50 per min)</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">£615.00</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">CG124</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<b>Total cost including theatre time</b>
|
|
<sup>
|
|
(b)
|
|
</sup>
|
|
</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:middle;">
|
|
<b>£682.83</b>
|
|
</td><td headers="hd_h_niceng157er6.appi.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Hospital</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: PSSRU (Personal Social Services Research Unit)<a class="bibr" href="#niceng157er6.ref15" rid="niceng157er6.ref15"><sup>15</sup></a>; CG124<a class="bibr" href="#niceng157er6.ref64" rid="niceng157er6.ref64"><sup>64</sup></a></p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng157er6.appi.tab1_1"><p class="no_margin">Total costs excluding theatre time included the cost of 2 anaesthetists</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="niceng157er6.appi.tab1_2"><p class="no_margin">It was assumed that the cost of theatre time from CG124 did not include personnel costs</p></div></dd></dl><dl class="bkr_refwrap"><dt>(c)</dt><dd><div id="niceng157er6.appi.tab1_3"><p class="no_margin">NHS hospital is Peterborough and Stamford Hospitals NHS Foundation Trust which provided information for CG124<a class="bibr" href="#niceng157er6.ref64" rid="niceng157er6.ref64"><sup>64</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng157er6appitab2"><div id="niceng157er6.appi.tab2" class="table"><h3><span class="label">Table 15</span><span class="title">Threshold analysis results</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appi.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appi.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng157er6.appi.tab2_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng157er6.appi.tab2_1_1_1_1" style="text-align:left;vertical-align:bottom;">Time to add nerve block</th><th id="hd_h_niceng157er6.appi.tab2_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng157er6.appi.tab2_1_1_1_2" style="text-align:left;vertical-align:bottom;">Theatre time included</th><th id="hd_h_niceng157er6.appi.tab2_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng157er6.appi.tab2_1_1_1_3" style="text-align:left;vertical-align:bottom;">Incremental cost</th><th id="hd_h_niceng157er6.appi.tab2_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng157er6.appi.tab2_1_1_1_4" style="text-align:left;vertical-align:bottom;">Gain in QALY needed</th><th id="hd_h_niceng157er6.appi.tab2_1_1_1_5" colspan="4" rowspan="1" style="text-align:left;vertical-align:bottom;">Health related quality of life gain needed in:</th></tr><tr><th headers="hd_h_niceng157er6.appi.tab2_1_1_1_5" id="hd_h_niceng157er6.appi.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24 hours</th><th headers="hd_h_niceng157er6.appi.tab2_1_1_1_5" id="hd_h_niceng157er6.appi.tab2_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 days</th><th headers="hd_h_niceng157er6.appi.tab2_1_1_1_5" id="hd_h_niceng157er6.appi.tab2_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 days</th><th headers="hd_h_niceng157er6.appi.tab2_1_1_1_5" id="hd_h_niceng157er6.appi.tab2_1_1_2_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30 days</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">30 mins</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Yes</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£682.83</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">0.034</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.462</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.154</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.246</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.415</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">10 mins</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Yes</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£236.83</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">0.012</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.322</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.441</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.432</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.144</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">5 mins</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Yes</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£125.33</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">0.006</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.287</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.762</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.229</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.076</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">30 mins</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">No</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£121.83</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">0.006</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.223</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.741</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.222</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.074</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">10 mins</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">No</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£49.83</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">0.002</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.909</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.303</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.091</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.030</td></tr><tr><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">5 mins</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">No</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£31.83</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">0.002</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.581</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.194</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.058</td><td headers="hd_h_niceng157er6.appi.tab2_1_1_1_5 hd_h_niceng157er6.appi.tab2_1_1_2_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.019</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er6appjtab1"><div id="niceng157er6.appj.tab1" class="table"><h3><span class="label">Table 16</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appj.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusion reason</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Abildgaard 2017<a class="bibr" href="#niceng157er6.ref1" rid="niceng157er6.ref1"><sup>1</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Aksu 2015<a class="bibr" href="#niceng157er6.ref2" rid="niceng157er6.ref2"><sup>2</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Angerame 2017<a class="bibr" href="#niceng157er6.ref3" rid="niceng157er6.ref3"><sup>3</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study without adjustment for confounding factors</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atchabahian 2015<a class="bibr" href="#niceng157er6.ref4" rid="niceng157er6.ref4"><sup>4</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review with different inclusion criteria however included studies were checked for this review</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Auyong 2017<a class="bibr" href="#niceng157er6.ref5" rid="niceng157er6.ref5"><sup>5</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Axelsson 2008<a class="bibr" href="#niceng157er6.ref6" rid="niceng157er6.ref6"><sup>6</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Balocco 2018<a class="bibr" href="#niceng157er6.ref7" rid="niceng157er6.ref7"><sup>7</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review of bupivacaine formulations</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Beaudet 2008<a class="bibr" href="#niceng157er6.ref8" rid="niceng157er6.ref8"><sup>8</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bishop 2005<a class="bibr" href="#niceng157er6.ref9" rid="niceng157er6.ref9"><sup>9</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Boddu 2018<a class="bibr" href="#niceng157er6.ref11" rid="niceng157er6.ref11"><sup>11</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study without adjustment for confounding factors</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cao 2017<a class="bibr" href="#niceng157er6.ref12" rid="niceng157er6.ref12"><sup>12</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review with different inclusion criteria however included studies were checked for this review</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Choi 2008<a class="bibr" href="#niceng157er6.ref13" rid="niceng157er6.ref13"><sup>13</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not in English</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Codding 2018<a class="bibr" href="#niceng157er6.ref14" rid="niceng157er6.ref14"><sup>14</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Overview of anaesthesia for shoulder surgery</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Desmet 2013<a class="bibr" href="#niceng157er6.ref16" rid="niceng157er6.ref16"><sup>16</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Desmet 2015<a class="bibr" href="#niceng157er6.ref17" rid="niceng157er6.ref17"><sup>17</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dorman 1994<a class="bibr" href="#niceng157er6.ref19" rid="niceng157er6.ref19"><sup>19</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ekatodramis 2003<a class="bibr" href="#niceng157er6.ref20" rid="niceng157er6.ref20"><sup>20</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eroglu 2004<a class="bibr" href="#niceng157er6.ref21" rid="niceng157er6.ref21"><sup>21</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Flory 1995<a class="bibr" href="#niceng157er6.ref22" rid="niceng157er6.ref22"><sup>22</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gabriel 2017<a class="bibr" href="#niceng157er6.ref23" rid="niceng157er6.ref23"><sup>23</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear if the study population is people undergoing primary knee arthroplasty</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ghaleb 2004<a class="bibr" href="#niceng157er6.ref24" rid="niceng157er6.ref24"><sup>24</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Overview of anaesthesia for shoulder surgery</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Goebel 2010<a class="bibr" href="#niceng157er6.ref25" rid="niceng157er6.ref25"><sup>25</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gohl 2001<a class="bibr" href="#niceng157er6.ref26" rid="niceng157er6.ref26"><sup>26</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gottschalk 2003<a class="bibr" href="#niceng157er6.ref27" rid="niceng157er6.ref27"><sup>27</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Grossi 1998<a class="bibr" href="#niceng157er6.ref28" rid="niceng157er6.ref28"><sup>28</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Guo 2017<a class="bibr" href="#niceng157er6.ref29" rid="niceng157er6.ref29"><sup>29</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review with different inclusion criteria however included studies were checked for this review</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gwam 2017<a class="bibr" href="#niceng157er6.ref30" rid="niceng157er6.ref30"><sup>30</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Knee arthroplasty study</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Haasio 1990<a class="bibr" href="#niceng157er6.ref31" rid="niceng157er6.ref31"><sup>31</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hamdani 2014<a class="bibr" href="#niceng157er6.ref32" rid="niceng157er6.ref32"><sup>32</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hannan 2016<a class="bibr" href="#niceng157er6.ref34" rid="niceng157er6.ref34"><sup>34</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study without adjustment for confounding factors</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Herrick 2018<a class="bibr" href="#niceng157er6.ref35" rid="niceng157er6.ref35"><sup>35</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Included people having revision arthroplasty</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hofmann-kiefer 2008<a class="bibr" href="#niceng157er6.ref36" rid="niceng157er6.ref36"><sup>36</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hong 2003<a class="bibr" href="#niceng157er6.ref37" rid="niceng157er6.ref37"><sup>37</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Huang 2017<a class="bibr" href="#niceng157er6.ref38" rid="niceng157er6.ref38"><sup>38</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review of shoulder analgesia</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ikemoto 2010<a class="bibr" href="#niceng157er6.ref39" rid="niceng157er6.ref39"><sup>39</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ilfeld 2003<a class="bibr" href="#niceng157er6.ref40" rid="niceng157er6.ref40"><sup>40</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ilfeld 2004<a class="bibr" href="#niceng157er6.ref41" rid="niceng157er6.ref41"><sup>41</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ilfeld 2006<a class="bibr" href="#niceng157er6.ref42" rid="niceng157er6.ref42"><sup>42</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Includes people undergoing revision shoulder replacement surgery</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Im 2007<a class="bibr" href="#niceng157er6.ref43" rid="niceng157er6.ref43"><sup>43</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not in English</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jochum 1997<a class="bibr" href="#niceng157er6.ref44" rid="niceng157er6.ref44"><sup>44</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not in English</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kahn 1999<a class="bibr" href="#niceng157er6.ref45" rid="niceng157er6.ref45"><sup>45</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kim 2017<a class="bibr" href="#niceng157er6.ref46" rid="niceng157er6.ref46"><sup>46</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kinnard 1994<a class="bibr" href="#niceng157er6.ref48" rid="niceng157er6.ref48"><sup>48</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kinnard 1995<a class="bibr" href="#niceng157er6.ref47" rid="niceng157er6.ref47"><sup>47</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kocamanoğlu 2005<a class="bibr" href="#niceng157er6.ref49" rid="niceng157er6.ref49"><sup>49</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not in English</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kostadinova 2009<a class="bibr" href="#niceng157er6.ref50" rid="niceng157er6.ref50"><sup>50</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unable to obtain</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Krone 2001<a class="bibr" href="#niceng157er6.ref51" rid="niceng157er6.ref51"><sup>51</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lee 2010<a class="bibr" href="#niceng157er6.ref52" rid="niceng157er6.ref52"><sup>52</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not in English</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lehmann 2015<a class="bibr" href="#niceng157er6.ref53" rid="niceng157er6.ref53"><sup>53</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lehtipalo 1999<a class="bibr" href="#niceng157er6.ref54" rid="niceng157er6.ref54"><sup>54</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mahmoodpoor 2011<a class="bibr" href="#niceng157er6.ref55" rid="niceng157er6.ref55"><sup>55</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mariano 2009<a class="bibr" href="#niceng157er6.ref56" rid="niceng157er6.ref56"><sup>56</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mclaughlin 2018<a class="bibr" href="#niceng157er6.ref58" rid="niceng157er6.ref58"><sup>58</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Included people having revision arthroplasty</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mueller 2017<a class="bibr" href="#niceng157er6.ref59" rid="niceng157er6.ref59"><sup>59</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Included people having revision arthroplasty</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Muittari 1998<a class="bibr" href="#niceng157er6.ref60" rid="niceng157er6.ref60"><sup>60</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Namdari 2018<a class="bibr" href="#niceng157er6.ref62" rid="niceng157er6.ref62"><sup>62</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Niiya 2010<a class="bibr" href="#niceng157er6.ref65" rid="niceng157er6.ref65"><sup>65</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not in English</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Park 2006<a class="bibr" href="#niceng157er6.ref67" rid="niceng157er6.ref67"><sup>67</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not in English</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pearson 2015<a class="bibr" href="#niceng157er6.ref68" rid="niceng157er6.ref68"><sup>68</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pere 1993<a class="bibr" href="#niceng157er6.ref69" rid="niceng157er6.ref69"><sup>69</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Renes 2009<a class="bibr" href="#niceng157er6.ref70" rid="niceng157er6.ref70"><sup>70</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rosenfeld 2016<a class="bibr" href="#niceng157er6.ref71" rid="niceng157er6.ref71"><sup>71</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Routman 2017<a class="bibr" href="#niceng157er6.ref72" rid="niceng157er6.ref72"><sup>72</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study without adjustment for confounding factors</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sabesan 2017<a class="bibr" href="#niceng157er6.ref73" rid="niceng157er6.ref73"><sup>73</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sermeus 2016<a class="bibr" href="#niceng157er6.ref74" rid="niceng157er6.ref74"><sup>74</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sicard 2019<a class="bibr" href="#niceng157er6.ref75" rid="niceng157er6.ref75"><sup>75</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Singelyn 1999<a class="bibr" href="#niceng157er6.ref76" rid="niceng157er6.ref76"><sup>76</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Soeding 2013<a class="bibr" href="#niceng157er6.ref77" rid="niceng157er6.ref77"><sup>77</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Song 2011<a class="bibr" href="#niceng157er6.ref78" rid="niceng157er6.ref78"><sup>78</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Stevens 2007<a class="bibr" href="#niceng157er6.ref79" rid="niceng157er6.ref79"><sup>79</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Stundner 2016<a class="bibr" href="#niceng157er6.ref80" rid="niceng157er6.ref80"><sup>80</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sun 2018<a class="bibr" href="#niceng157er6.ref82" rid="niceng157er6.ref82"><sup>82</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review with different inclusion criteria however included studies were checked for this review</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tamosiūnas 2004<a class="bibr" href="#niceng157er6.ref83" rid="niceng157er6.ref83"><sup>83</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not in English</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tantry 2016<a class="bibr" href="#niceng157er6.ref84" rid="niceng157er6.ref84"><sup>84</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tashjian 2016<a class="bibr" href="#niceng157er6.ref85" rid="niceng157er6.ref85"><sup>85</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Included people having revision arthroplasty</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tetzlaff 1995<a class="bibr" href="#niceng157er6.ref86" rid="niceng157er6.ref86"><sup>86</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Trabelsi 2015<a class="bibr" href="#niceng157er6.ref88" rid="niceng157er6.ref88"><sup>88</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unable to obtain</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Trabelsi 2017<a class="bibr" href="#niceng157er6.ref87" rid="niceng157er6.ref87"><sup>87</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tran 2017<a class="bibr" href="#niceng157er6.ref89" rid="niceng157er6.ref89"><sup>89</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review of diaphragm sparing nerve blocks</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ullah 2014<a class="bibr" href="#niceng157er6.ref90" rid="niceng157er6.ref90"><sup>90</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review with different inclusion criteria however included studies were checked for this review</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Verelst 2013<a class="bibr" href="#niceng157er6.ref91" rid="niceng157er6.ref91"><sup>91</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review of analgesic strategies</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vorobeichik 2018<a class="bibr" href="#niceng157er6.ref92" rid="niceng157er6.ref92"><sup>92</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review with different inclusion criteria however included studies were checked for this review</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Warrender 2017<a class="bibr" href="#niceng157er6.ref93" rid="niceng157er6.ref93"><sup>93</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review with a different population.</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Weller 2017<a class="bibr" href="#niceng157er6.ref94" rid="niceng157er6.ref94"><sup>94</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study without adjustment for confounding factors</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wiegel 2017<a class="bibr" href="#niceng157er6.ref95" rid="niceng157er6.ref95"><sup>95</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unable to obtain</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wiesmann 2016<a class="bibr" href="#niceng157er6.ref96" rid="niceng157er6.ref96"><sup>96</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wurm 2003<a class="bibr" href="#niceng157er6.ref97" rid="niceng157er6.ref97"><sup>97</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yadeau 2016<a class="bibr" href="#niceng157er6.ref98" rid="niceng157er6.ref98"><sup>98</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yan 2017<a class="bibr" href="#niceng157er6.ref99" rid="niceng157er6.ref99"><sup>99</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review with different inclusion criteria however included studies were checked for this review</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yang 2010<a class="bibr" href="#niceng157er6.ref101" rid="niceng157er6.ref101"><sup>101</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yang 2013<a class="bibr" href="#niceng157er6.ref100" rid="niceng157er6.ref100"><sup>100</sup></a></td><td headers="hd_h_niceng157er6.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er6appjtab2"><div id="niceng157er6.appj.tab2" class="table"><h3><span class="label">Table 17</span><span class="title">Studies excluded from the health economic review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appj.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appj.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng157er6.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference</th><th id="hd_h_niceng157er6.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er6.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hamilton 2019<a class="bibr" href="#niceng157er6.ref33" rid="niceng157er6.ref33"><sup>33</sup></a></td><td headers="hd_h_niceng157er6.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No intraoperative costs were captured</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er6appktab1"><div id="niceng157er6.appk.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appk.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appk.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng157er6.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PICO question</th><td headers="hd_b_niceng157er6.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Population: People undergoing primary shoulder replacement surgery Intervention(s):
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<ul><li class="half_rhythm"><div>General anaesthesia with LIA</div></li><li class="half_rhythm"><div>General anaesthesia with nerve blocks</div></li><li class="half_rhythm"><div>General anaesthesia with regional anaesthesia</div></li></ul>
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Comparison: a comparison of interventions</p>
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<p>Outcome(s): Transfusion rates, length of stay, post-operative analgesia requirements, postoperative pain, Patient Reported Outcome Measures (PROMs)</p>
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</td></tr><tr><th id="hd_b_niceng157er6.appk.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng157er6.appk.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td></tr><tr><th id="hd_b_niceng157er6.appk.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other details</th><td headers="hd_b_niceng157er6.appk.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Time taken for regional blocks to be enacted can be between 5 mins to 30 minutes based on experience of anaesthetist carrying out procedure. This has a cost implications to the NHS</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er6appltab1"><div id="niceng157er6.appl.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561389/table/niceng157er6.appl.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er6.appl.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng157er6.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PICO question</th><td headers="hd_b_niceng157er6.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Population: People undergoing primary shoulder replacement surgery Intervention(s):
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<ul><li class="half_rhythm"><div>General anaesthesia</div></li><li class="half_rhythm"><div>Regional anaesthesia</div></li><li class="half_rhythm"><div>General anaesthesia with regional anaesthesia</div></li></ul>
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Comparison: a comparison of interventions</p>
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<p>Outcome(s): Transfusion rates, length of stay, post-operative analgesia requirements, postoperative pain, Patient Reported Outcome Measures (PROMs)</p>
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</td></tr><tr><th id="hd_b_niceng157er6.appl.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng157er6.appl.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td></tr><tr><th id="hd_b_niceng157er6.appl.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other details</th><td headers="hd_b_niceng157er6.appl.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>No existing national priorities.</div></li><li class="half_rhythm"><div>Day case joint replacement would be important to patients as reduced length of stay is thought to increase person’s wellbeing.</div></li><li class="half_rhythm"><div>This would inform future NICE guidance on anaesthesia for primary shoulder replacement surgery.</div></li></ul></td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script><script type="text/javascript" src="/core/mathjax/2.7.9/MathJax.js?config=TeX-AMS-MML_SVG"> </script></div></div>
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