{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T05:15:09Z","timestamp":1785474909850,"version":"3.56.0"},"reference-count":17,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2019,8,21]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Variation in clinical practice is often considered unwarranted when it does not reflect patient preference or evidence-based medicine. Complications from regional anesthesia such as nerve injury and systemic toxicity are dose dependent. It is currently unclear if there is significant variation with the dosing of local anesthetics (LA) in the context of the modern practice of peripheral regional anesthesia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analyzed data from the International Registry of Regional Anesthesia that include prospective data on peripheral regional anesthesia procedures from 21 centers located around the world. Using data from years 2011 to 2017, our primary aim was to characterize the degree of variation in dosing of LA for the top 10 most commonly performed single injection peripheral nerve blocks. Our secondary aim was to identify potential drivers of this variation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among the 26\u2009457 peripheral blocks performed, mean (\u00b1SD) LA dose per block in ropivacaine equivalents was 125.1\u00b151.2\u2009mg and 1.6\u00b10.7 for mg\/kg. There was large variation across all block types, with the highest variation (measured by interdecile range) in axillary blocks (143.8\u2009mg) and lowest in interscalene blocks (83.3\u2009mg). In a regression analysis, dose was primarily associated with the hospital (Cohen\u2019s f=0.37) where the block was administered and block type (f=0.38), less so with age (f=0.02), weight (f=0.12), gender (f=0.05) or LA (f=0.17) used. Hospital site had strong impact on variation in LA dose (f=0.88). Variation was not significantly associated with number of blocks performed by hospital site.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Large variation in dosing for regional blocks exists within and among hospitals, which is unlikely to be warranted. For many blocks, the variation of dosing is larger than the mean dose. Hospital site had strong impact on variation in LA dose and moderate impact on mean LA dose.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2019-100650","type":"journal-article","created":{"date-parts":[[2019,9,7]],"date-time":"2019-09-07T07:39:09Z","timestamp":1567841949000},"page":"998-1002","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Settled science or unwarranted variation in local anesthetic dosing? An analysis from an International Registry of Regional Anesthesiology"],"prefix":"10.1136","volume":"44","author":[{"given":"Andreas H","family":"Taenzer","sequence":"first","affiliation":[{"name":"Anesthesiology, Dartmouth Medical School, Hanover, New Hampshire, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian D","family":"Sites","sequence":"additional","affiliation":[{"name":"Anesthesiology, Dartmouth Medical School, Hanover, New Hampshire, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Kluger","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Barrington","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,9,6]]},"reference":[{"key":"2025101112403309000_44.11.998.1","first-page":"1219","article-title":"The incidence of tonsillectomy in school children: (Section of epidemiology and state medicine)","volume":"31","author":"Glover","year":"1938","journal-title":"Proc R Soc Med"},{"key":"2025101112403309000_44.11.998.2","doi-asserted-by":"publisher","DOI":"10.1126\/science.182.4117.1102"},{"key":"2025101112403309000_44.11.998.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.325.7370.961"},{"key":"2025101112403309000_44.11.998.4","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1111\/anae.12629","article-title":"Peripheral nerve block and local anaesthetic dose, how much is enough?","volume":"69","author":"O'Donnell","year":"2014","journal-title":"Anaesthesia"},{"key":"2025101112403309000_44.11.998.5","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e3181ae72e8"},{"key":"2025101112403309000_44.11.998.6","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e318292669b"},{"key":"2025101112403309000_44.11.998.7","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000162"},{"key":"2025101112403309000_44.11.998.8","doi-asserted-by":"crossref","unstructured":"Casati A , Fanelli G , Magistris L , et al . Minimum Local Anesthetic Volume Blocking the Femoral Nerve in 50% of Cases: A Double-Blinded Comparison Between 0.5% Ropivacaine and 0.5% Bupivacaine. Anesth Analg 2001:205\u20138.doi:10.1097\/00000539-200101000-00039","DOI":"10.1097\/00000539-200101000-00039"},{"key":"2025101112403309000_44.11.998.9","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/82.3.371"},{"key":"2025101112403309000_44.11.998.10","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3181a915c7"},{"key":"2025101112403309000_44.11.998.11","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2018-100043"},{"key":"2025101112403309000_44.11.998.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.rapm.2004.08.003"},{"key":"2025101112403309000_44.11.998.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2009.01.015"},{"key":"2025101112403309000_44.11.998.14","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e31825d9f4b"},{"key":"2025101112403309000_44.11.998.15","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1097\/ALN.0000000000002372","article-title":"Complications in pediatric regional anesthesia","volume":"129","author":"Walker","year":"2018","journal-title":"Anesthesiology"},{"key":"2025101112403309000_44.11.998.16","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000166"},{"key":"2025101112403309000_44.11.998.17","doi-asserted-by":"crossref","unstructured":"Taenzer AH , Walker BJ , Bosenberg AT , et al . Asleep versus awake: does it matter?: pediatric regional block complications by patient state: a report from the pediatric regional anesthesia network. Reg Anesth Pain Med 2014;39.","DOI":"10.1097\/AAP.0000000000000102"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2019-100650","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T19:40:39Z","timestamp":1760211639000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2019-100650"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,6]]},"references-count":17,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2019,10,17]]},"published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1136\/rapm-2019-100650"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2019-100650","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9,6]]}}}