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Pain Manag. 2018 Nov 1;8(6):475-485. doi: 10.2217/pmt-2018-0017. Epub 2018 Nov 5.

A pragmatic approach to evaluating new techniques in regional anesthesia and acute pain medicine.

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Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA, USA.
Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA.
Departments of Anesthesiology and Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.


Anesthesiologists set up regional anesthesia and acute pain medicine programs in order to improve the patient outcomes and experience. Given the increasing frequency and volume of newly described techniques, applying a pragmatic framework can guide clinicians on how to critically review and consider implementing the new techniques into clinical practice. A proposed framework should consider how a technique: increases access; enhances efficiency; decreases disparities and improves outcomes. Quantifying the relative contribution of these four factors using a point system, which will be specific to each practice, can generate an overall scorecard to help clinicians make decisions on whether or not to incorporate a new technique into clinical practice or replace an incumbent technique within a clinical pathway.


access; disparities; efficiency; grading system; implementation; novel techniques; outcomes; regional anesthesia

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