Anesthesia Technique: Peripheral Nerve Block

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Description

This phenotype is used to determine if a peripheral nerve block was attempted or placed for a given case.

Limitation

Variance in electronic health record documentation or incorrect variable mapping may produce an incorrect result for a case. This phenotype is limited to variables mapped to regional block MPOG concepts and examines only the documentation within those notes for specific peripheral nerve block text. This phenotype will result if the block was attempted; it does not differentiate if the attempt was successful. All regional block notes documented in the perioperative period will be examined however, the results of this phenotype do not differentiate whether the block was attempted before, after, or during a procedure.

Data quality is limited to individual site documentation accuracy, completeness, and variable mapping, which is performed by each site, independently. MPOG, as the coordinating center, reviews data quality at each data upload and monthly via Data Diagnostics and Case Validation tools. This review, while thorough, may not contain all data elements relevant to this phenotype and thus should be carefully reviewed by the user.

Value Type

Categorical

Enumeration

Value	Value Code	Definition

Return Columns

Column Name	Data Type

Granularity

Logic

Start with all cases.

First, compile a list of all peripheral nerve blocks that may be documented on the case using steps 1-3.

Step 1: Determine if the case has any notes associated with peripheral nerve blocks

1. Evaluate if the case has any of these MPOG note concepts documented with an observed time between 24 hours before anes start through 24 hours after anesthesia end; if observed time is not documented, will use entered time:

50065 Regional - Cervical Plexus Block
50081 Regional - Adductor Canal Block Performed
50383 Regional - Supraclavicular Block
50384 Regional - Interscalene Block
50385 Regional - Infraclavicular Block
50386 Regional - Axillary Block
50387 Regional - Femoral Nerve Block
50388 Regional - Popliteal Block
50389 Regional - Sciatic Block
50390 Regional - Ankle Block
50391 Regional - Bier Block
50398 Regional - Lumbar Plexus Block
50629 Regional - Retrobulbar Block by surgeon
50724 Regional - Superior Laryngeal Block
50765 Regional - Saphenous Nerve Block
50798 Regional - Inguinal Field Block
50808 Regional - Transversus Abdominis Plane (TAP) Block
50243 Regional - Quadratus Lumborum Block
50624 Regional - Infiltration between Popliteal Artery and Capsule of Knee (IPACK) Block
50260 Regional - Serratus Plane Block
50263 Regional - Pectoralis Block (PECS I or II)

2. If only one of the above note concepts is present, assign the block type as listed in the concept to the case and move to step 2.

3. If more than one of the above note concepts is present, add Block, Multiple Types and move to step 2.

4. If none of the above note concepts are present, move to step 2.

Step 2. Determine if the case has any regional note concepts with text indicating a peripheral nerve block was attempted/used.

1. Evaluate if the case has any of the following MPOG note concepts documented with an observed time befween 24 hours before anes start through 24 hours after anesthesia end; if observed time is not documented, will use entered time:

50021 Regional- Peripheral Nerve Catheter Placed
50356 Regional- Block Performed
50690 Categorized Note- Regional Anesthesia
50665 Procedures - Other unlisted procedure
50282 Regional - Block Placement Details
50254 Categorized note: Regional or neuraxial note
- Exclusion Text: Spinal, Epidural, Cuadal

2. If any of the above note concepts (50021, 50356, 50690, 50665, 50282) are present, evaluate if any of the notes have the following text and then proceed to the next step:

If text 'femoral' is present, add 'Femoral Nerve'
If text 'bier' is present, add 'Bier'
If text 'retrobul' is present, add 'Retrobulbar'
If text 'eye block' is present, add 'Eye Block'
If text 'cervical plex' OR 'cervical paraver' is present, add 'Cervical Plexus'
If text 'interscal' is present, add 'Interscalene'
If text 'axillary' is present, add 'Axillary'
If text 'transversus abdom' OR 'TAP' is present, add 'Transversus Abdominis Plane (TAP)'
If text 'lumbar plexus' is present, add 'Lumbar Plexus'
If text 'inguinal' is present, add 'Inguinal'
If text 'sciatic' is present, add 'Sciatic'
If 'saphenous' is present, add 'Saphenous Nerve'
If text 'supraclav' is present, add 'Supraclavicular'
If text 'popliteal' OR 'peroneal' OR 'IPACK' is present, add 'Popliteal'
If text 'superior laryngeal' is present, add 'Superior Laryngeal'
If text 'adductor can' is present, add 'Adductor Canal'
If text 'infraclav' is present, add 'Infraclavicular'
If text 'ankle' is present, add 'Ankle'
If text 'quadratus lum' or 'QL b' is present, add 'Quadratus Lumborum'
If text 'fascia ili' is present, add 'Fascia Iliaca'
If text 'serratus’ is present, add 'Serratus Plane'
If text 'pec’ is present, add 'Pectoralis'
If text 'other' present add 'Block, Unknown Type'
If concept id is 50665 and text 'peripheral' present and procedure text contains block, then add 'Block, Unknown Type'
If CPT 01991 is present AND the Case Procedure Text contains the text 'block' add 'Block, Unknown Type'

3. If peripheral nerve block text listed in the prior step are not identified within the note concepts 50021, assign 'Block, Unknown Type' and continue to step 3.

50356, 50690 or 50282,

4. If peripheral nerve block text is not identified within the note concept 50356 or 50665 or 50690, continue to step 3.

5. If none of the regional block concepts are present (50021, 50356, 50690, 50665), continue to step 3.

Step 3: Compile complete list of peripheral nerve block types that a case qualifies for based on steps 1-2. One case can have zero, one, or many assigned block types at this point.

If multiple specific block types result from steps 1-2, then the final result will be 'Block, Multiple Types Listed'
If no blocks result from steps 1-2, move to step 4.
If case has only 'Block, Unknown Type' from step 1 & 2 and no other blocks from step 1, then the final result will be 'Block, Unknown Type'
If case has a specific block type from step 1 and a 'Block, Unknown Type' from step 2, then final result will be specific block type identified in step 1.
If case has only 'Cervical Plexus' from steps 1-2, then the final result will be 'Cervical Plexus'
If case has only 'Adductor Canal' from steps 1-2, then the final result will be 'Adductor Canal'
If case has only 'Supraclavicular' from steps 1-2, then the final result will be 'Supraclavicular'
If case has only 'Interscalene' from steps 1-2, then the final result will be 'Interscalene'
If case has only 'Infraclavicular' from steps 1-2, then the final result will be 'Infraclavicular'
If case has only 'Axillary' from steps 1-2, then the final result will be 'Axillary'
If case has only 'Femoral Nerve' from steps 1-2, then the final result will be 'Femoral Nerve'
If case has only 'Popliteal' from steps 1-2, then the final result will be 'Popliteal'
If case has only 'Sciatic' from steps 1-2, then the final result will be 'Sciatic'
If case has only 'Ankle' from steps 1-2, then the final result will be 'Ankle'
If case has only 'Bier' from steps 1-2, then the final result will be 'Bier'
If case has only 'Lumbar Plexus' from steps 1-2, then the final result will be 'Lumbar Plexus'
If case has only 'Retrobulbar' from steps 1-2, then the final result will be 'Retrobulbar'
If case has only 'Superior Laryngeal' from steps 1-2, then the final result will be 'Superior Laryngeal'
If case has only 'Saphenous Nerve' from steps 1-2, then the final result will be 'Saphenous Nerve'
If case has only 'Inguinal' from steps 1-2, then the final result will be 'Inguinal'
If case has only 'Transverus Abdominis Plane (TAP)' from steps 1-2, then the final result will be 'Transversus Abdominis Plane (TAP)'
If case has only 'Eye Block' from steps 1-2, then the final result will be 'Eye Block'
If case has only 'Quadratus Lumborum' from steps 1-2, then the final result will be 'Quadratus Lumborum'
If case has only 'Serratus Plane' from steps 1-2, then the final result will be 'Serratus Plane'
If case has only 'Pectoralis' from steps 1-2, then the final result will be 'Pectoralis'

Step 4: (Only assessed if steps 1-3 do not identify any block concepts.)

Determine if the case has any route of administration associated with peripheral nerve blocks:

1. Evaluate if the case has one of these route of administration MPOG concepts:

2019 Perineural (Route of Administration)
2020 Bier Block (Route of Administration)

2. If the Perineural route of administration concept is present, then the final result will be 'Perineural Block'

3. If the Bier Block route of administration concept is present, then the final result will be ‘Bier Block’

4. If both routes of administration concepts are present, then the final result will be 'Block, Multiple Types Listed'

5. If none of the above route of administration concepts are present, then the final result will be 'None'