{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T11:50:44Z","timestamp":1792929044340,"version":"4.5.0"},"reference-count":32,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2025,9,30]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Regional anesthesia (RA) is central to multimodal analgesia, yet many supporting randomized controlled trials (RCTs) may lack the rigor needed for evidence-based block selection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      To evaluate the clinical usefulness and transparency of RCTs investigating RA interventions for lower extremity surgeries, using the van \u2019t Hooft\n                      <jats:italic>et al<\/jats:italic>\n                      framework.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Embase\/MEDLINE were searched for RCTs (2014\u20132024) examining RA interventions for lower-extremity surgery. Data were extracted in duplicate using clinical-utility and transparency criteria. Analyses included descriptive statistics, linear regression for temporal trends, Pearson correlation, and multivariable regression to identify predictors of usefulness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 248 RCTs, patient-centeredness was universal, while feasibility (77.0%) and context placement (77.4%) were common. Pragmatism (2.0%) and value-for-money analyses (0%) were rare. Transparency varied: conflicts of interest were disclosed in 88.7%, pre-registration occurred in 39.9%, public protocols in 10.1%, and raw-data sharing in 1.2%. Transparency improved over time, correlated with clinical-utility scores (r=0.32, p&lt;0.001) and was greater in hospital-funded, self-funded, and higher-impact journals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations<\/jats:title>\n                    <jats:p>Usefulness scoring involves subjective judgment; non-English trials were excluded; the absence of formal risk of bias analysis limits interpretability of trial quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussions\/conclusions<\/jats:title>\n                    <jats:p>Although transparency is improving, most trials remain insufficiently pragmatic, lack economic evaluation, and rarely share data, limiting real-world applicability. The results of this study suggest that aligning funder, journal, and collaborative expectations around open science and pragmatic design could accelerate the generation of high-utility evidence for perioperative block selection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2025-107065","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T08:05:10Z","timestamp":1760429110000},"page":"1221-1228","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical utility of randomized controlled trials of regional anesthesia for lower-extremity surgery: a systematic review"],"prefix":"10.1136","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6997-5503","authenticated-orcid":false,"given":"Danielle","family":"Waller","sequence":"first","affiliation":[{"name":"Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josh","family":"Saurino","sequence":"additional","affiliation":[{"name":"Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1358-5119","authenticated-orcid":false,"given":"Adam","family":"Khan","sequence":"additional","affiliation":[{"name":"Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Gardner","sequence":"additional","affiliation":[{"name":"Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alec","family":"Young","sequence":"additional","affiliation":[{"name":"Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chance","family":"Bratten","sequence":"additional","affiliation":[{"name":"Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eli","family":"Paul","sequence":"additional","affiliation":[{"name":"Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Dunford","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Will","family":"Roberts","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Relic","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia I","family":"Ford","sequence":"additional","affiliation":[{"name":"Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA"},{"name":"Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matt","family":"Vassar","sequence":"additional","affiliation":[{"name":"Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA"},{"name":"Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"2026100502151109000_51.10.1221.1","unstructured":"American joint replacement registry surpasses 4 million captured hip and knee arthroplasty procedures. 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