Regional anesthesia is a rapidly growing subspecialty, with a widening spectrum of applications and uses. Despite growth in this area of research, there have been few published regional anesthesia systematic reviews, meta-analyses, Cochrane reviews, or National Institute for Health and Care Excellence (NICE) guidelines exploring pain outcomes. This may be due to the heterogeneity of outcome variables chosen in regional anesthesia studies, making it difficult to combine and analyse data.
The Cochrane Collaboration, which aims to give the “clinical bottom line” through its reviews, has 39 reviews, which mention regional anesthesia. These reviews commonly cite the outcomes chosen as “incomplete,” “poor quality,” and “heterogeneous,” which impeded the authors’ ability to draw meaningful conclusions [
Identification of outcomes utilised can subsequently help to create a definitive list of core outcomes, which may guide future researchers when designing studies. This systematic review aimed to explore outcomes utilised in regional anesthesia randomized controlled trials (RCTs) to measure postoperative pain.
We have adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards in this article [
We performed a literature search using three search engines (Medline, Embase, and CINAHL). These databases were searched for RCTs published between 2005 and 2017. The search strategy included manual searching of citations for further relevant articles. The search was initially performed in mid December 2016 and repeated on January 5th 2017. An example of the exact search terms used for each database is included in Appendix
The selected studies were analysed by two of the authors (E. Pushpanathan and T. Setty). Each study was read and the following data were extracted and tabulated: authors, year of publication, postoperative pain outcome measures utilised, times of postoperative pain assessment, nerve block studied, and personnel collecting the data. The two primary outcomes explored in this systematic review were the type of pain outcome measured and the time of measurement.
The quality of studies included in this systematic review was evaluated using the Cochrane Collaboration’s tool for assessing risk of bias [
The search identified 407 articles. One author screened the titles and abstracts of these articles, and 308 were excluded. Two authors reviewed the full text of the remaining 99 articles. Of those excluded, 20 were duplicates and 18 were not RCTs. Of the remaining excluded articles, 5 were pediatric studies, 2 were obstetric, 3 were systematic reviews or meta-analyses, 2 were foreign language, 7 did not have postoperative pain as a primary outcome, and 11 were abbreviated studies in supplements so lacked sufficient detail. The results of the literature search are summarised in Figure
Summary of literature search and included studies.
Summary of measurement timings of pain outcomes utilised in included studies.
Author/year | Country of study | Measurement tool | Time measured | Nerve block |
---|---|---|---|---|
Ambrosoli et al. [ |
Not stated | NRS (not stated; 0–10) | 4 hours post-op | Sciatic nerve catheter |
Upon discharge | ||||
NRS at rest (0–10) | 24 hours | |||
48 hours | ||||
NRS on activity (0–10) | 24 hours | |||
48 hours | ||||
Number of occasions sleep was disturbed by pain | 24 hours | |||
48 hours | ||||
|
||||
Andersen et al. [ |
Denmark | Worst pain during knee movement | On day of surgery | Saphenous nerve block |
VAS (10 cm) at rest | ||||
Time from surgery to VAS score 3 (not stated) | Hours | |||
Sleep disturbance due to pain (yes/no) | D1 post-op | |||
D2 post-op | ||||
D3 post-op | ||||
Total opioid consumption | 48 hours | |||
|
||||
Bengisun et al. [ |
Turkey | VAS (10 cm; not stated) | 2 hours post-op | Interscalene block |
4 hours post-op | ||||
6 hours post-op | ||||
12 hours post-op | ||||
24 hours post-op | ||||
|
||||
Bharti et al. [ |
India | VAS (10 cm; not stated) | Every 30 min for 2 hours | Supraclavicular brachial plexus block |
Every 1 hour for 6 hours | ||||
Every 2 hours for 12 hours | ||||
24 hours post-op | ||||
Total analgesic requirement (opiate and nonopiate) | 24 hours post-op | |||
|
||||
Boussofara et al. [ |
Tunisia | VAS (10 cm; not stated) | Every 15 min post-op whilst in PACU | Spinal anaesthetic block |
Total opioid consumption | Whilst in PACU | |||
|
||||
Capdevilla et al. [ |
France | VAS (10 cm; not stated) | 10 min post-op | Interscalene and popliteal infusions |
1 hour post-op | ||||
4 hours post-op | ||||
12 hours post-op | ||||
AM D1 post-op during physiotx | ||||
AM D2 post-op during physiotx | ||||
AM D3 post-op during physiotx | ||||
AM D4 post-op during physiotx | ||||
Total analgesic consumption (nonopiate) | Over 72 hours | |||
|
||||
Choi et al. [ |
Canada | NRS on activity (0–10) | AM D2 post-op | Femoral nerve block continuous versus single |
Total opioid consumption | 48 hours | |||
NRS at rest (0–10) | AM D1 post-op | |||
NRS on activity (0–10) | D1 post-op | |||
Worst NRS (0–10) | D1 post-op | |||
NRS (0–10; not stated) | 4.5 months post-op | |||
|
||||
Diakomi et al. [ |
Greece | Time to first IV opioid request (hours) | No. of hours | Fascia iliaca block |
Total opioid consumption | Over first 24 hours | |||
|
||||
Elkassabany et al. [ |
USA | Pain scores (type of pain score not stated) | Before physiotherapy | Femoral nerve block versus adductor canal block |
Pain scores (type of pain score not stated) | After physiotherapy | |||
Pain scores (APS-POQ-R) | At 24 hours | |||
Total opioid consumption | AM D1 post-op | |||
AM D2 post-op | ||||
|
||||
Fredrickson et al. [ |
New Zealand | NRS (not stated; 0–10) | Emergence | Interscalene catheters |
Worst in 24 hours on movement | ||||
Worst in 24 hours at rest | ||||
Worst in second 24 hours on movement | ||||
Worst in second 24 hours at rest | ||||
|
||||
Fritsch et al. [ |
Austria | NRS at rest (0–10) | 4 hours post-op | Interscalene brachial plexus block |
6 hours post-op | ||||
8 hours post-op | ||||
10 hours post-op | ||||
12 hours post-op | ||||
14 hours post-op | ||||
NRS on activity (0–10) | 4 hours post-op | |||
6 hours post-op | ||||
8 hours post-op | ||||
10 hours post-op | ||||
12 hours post-op | ||||
14 hours post-op | ||||
|
||||
Hamdani et al. [ |
Switzerland | Average pain score (NRS; 0–10) (not stated) | Over first 24 hours | Continuous interscalene |
Average pain score (NRS; 0–10) (not stated) | Over first 48 hours | |||
Total opioid consumption | Over first 24 hours | |||
Total opioid consumption | Over first 48 hours | |||
Maximum pain score (NRS; 0–10) (not stated) | Over first 24 hours | |||
Maximum pain score (NRS; 0–10) (not stated) | Over first 48 hours | |||
|
||||
Karthikeyan et al. [ |
India | VAS (10 cm) (not stated) | Admission to PACU | Bilateral cervical plexus block |
2 hours post-op | ||||
4 hours post-op | ||||
6 hours post-op | ||||
8 hours post-op | ||||
16 hours post-op | ||||
24 hours post-op | ||||
Time to first analgesic request | Min | |||
Total analgesic consumption (opioid consumption) | 24 hours post-op | |||
|
||||
Kim et al. [ |
Republic of Korea | VAS (10 cm; not stated) | 1 hour post-op | Serratus-intercostal plane block and intermediate cervical plexus block versus control |
3 hours post-op | ||||
6 hours post-op | ||||
9 hours post-op | ||||
24 hours post-op | ||||
|
||||
Kulhari et al. [ |
Not stated | Time to first rescue analgesia | After administration of block | Pectoral nerve block versus thoracic paravertebral block |
Total analgesic consumption (opioid consumption) | 24 hours post-op | |||
VAS (10 cm; not stated) | 0 hours post-op | |||
0.5 hours post-op | ||||
1 hour post-op | ||||
2 hours post-op | ||||
4 hours post-op | ||||
6 hours post-op | ||||
8 hours post-op | ||||
12 hours post-op | ||||
24 hours post-op | ||||
|
||||
Moura et al. [ |
Brazil | NRS (not stated; 0–10) | T0 (after recovering consciousness) | Femoral nerve block |
1 hour post-op | ||||
2 hours post-op | ||||
Total dose of supplementary analgesia (opioid and nonopioid) | First 2 hours | |||
Time to first analgesic supplementation | ||||
|
||||
Nagafuchi et al. [ |
Japan | NRS (not stated; 0–10) | Exiting operating room | Femoral nerve block-sciatic nerve block versus femoral nerve block-LIA |
3 hours post-op | ||||
12 hours post-op | ||||
24 hours post-op | ||||
Total dose of diclofenac | ||||
|
||||
Salviz et al. [ |
USA | Time to first pain | Hours | Interscalene brachial plexus block |
Analgesic consumption (opioid) | D1 post-op | |||
D2 post-op | ||||
D3 post-op | ||||
D4 post-op | ||||
D5 post-op | ||||
D6 post-op | ||||
D7 post-op | ||||
Maximum NRS (not stated; 0–10) | D1 post-op | |||
D2 post-op | ||||
D3 post-op | ||||
D4 post-op | ||||
D5 post-op | ||||
D6 post-op | ||||
D7 post-op | ||||
|
||||
Sawhney et al. [ |
Canada | NRS on activity (0–10) | D1 post-op | Combined adductor canal block with periarticular infiltration versus adductor canal nerve block |
NRS at rest and with knee bending (0–10) | D1 post-op | |||
NRS on activity (0–10) | D2 post-op | |||
NRS at rest and with knee bending (0–10) | D2 post-op | |||
Analgesic consumption (opioid and nonopioid) per day | ||||
|
||||
Sato et al. [ |
Japan | VAS (10 cm) at rest | At rest just after surgery | Sciatic and femoral continuous versus single shot |
6 hours after surgery | ||||
AM D1 post-op | ||||
PM D1 post-op | ||||
AM D2 post-op | ||||
PM D2 post-op | ||||
Morphine consumption | Over first 48 hours | |||
|
||||
Siddiqui et al. [ |
USA | VAS (10 cm) at rest | Every 5 min first hour | Lumbar plexus block |
4 hours post-op | ||||
8 hours post-op | ||||
16 hours post-op | ||||
20 hours post-op | ||||
24 hours post-op | ||||
28 hours post-op | ||||
32 hours post-op | ||||
36 hours post-op | ||||
|
||||
Sindjelic et al. [ |
Serbia | Time to first analgesic request | Min | Cervical plexus block |
Total opioid consumption | 24 hours post-op | |||
|
||||
Schoenmakers et al. [ |
Netherlands | Time to first analgesic request | Min | Popliteal continuous |
NRS at rest (0–10) | Immediately post-op | |||
24 hours | ||||
NRS on activity (0–10) | Immediately post-op | |||
24 hours | ||||
|
||||
Subramanyam et al. [ |
Canada | NRS (not stated; 0–10) | 30 min post-op | Supraclavicular brachial plexus block |
60 min post-op | ||||
90 min post-op | ||||
Time to first analgesic request | Min | |||
|
||||
Stundner et al. [ |
Austria | NRS at rest (0–10) | Baseline before ISB | Interscalene brachial plexus block |
Immediately post-op | ||||
6 hours post-op worst pain | ||||
8 hours post-op worst pain | ||||
10 hours post-op worst pain | ||||
12 hours post-op worst pain | ||||
14 hours post-op worst pain | ||||
AM D1 post-op worst pain | ||||
NRS on activity (0–10) | Baseline before ISB | |||
Immediately post-op | ||||
6 hours post-op worst pain | ||||
8 hours post-op worst pain | ||||
10 hours post-op worst pain | ||||
12 hours post-op worst pain | ||||
14 hours post-op worst pain | ||||
AM D1 post-op worst pain | ||||
|
||||
Thybo et al. [ |
Denmark | VAS (10 cm) during 30° hip flexion | 4 hours post-op (T4) at T0 (pts able to move toes but before SAB worn off) | Lateral cutaneous femoral nerve block |
Pain at rest VAS (10 cm) and during 30° hip flexion | T0 | |||
Pain at rest VAS (10 cm) and during 30° hip flexion | T1 (after T0) | |||
Pain at rest VAS (10 cm) and during 30° hip flexion | T2 (after T0) | |||
Pain at rest VAS (10 cm) and during 30° hip flexion | T4 (after T0) | |||
Pain at rest VAS (10 cm) and during 30° hip flexion | T8 (after T0) | |||
Pain at rest VAS (10 cm) and during 30° hip flexion | T12 (after T0) | |||
Pain at rest VAS (10 cm) and during 30° hip flexion | T24 (after T0) | |||
Cumulative oxycodone consumption | 0–24 hours post-op | |||
|
||||
Wegener et al. [ |
Netherlands | WOMAC score | At rest at 3 months | Sciatic nerve block |
On mobilising at 3 months | ||||
At rest 12 months | ||||
On mobilising at 12 months | ||||
VAS (10 cm) | At rest 3 months | |||
On mobilising at 3 months | ||||
At rest 12 months | ||||
On mobilising at 12 months | ||||
Oxford knee score (inc. pain) | ||||
|
||||
Wegener et al. [ |
Netherlands | NRS at rest (0–10) | AM D1 post-op | Sciatic and femoral continuous versus single |
PM D1 post-op | ||||
AM D2 post-op | ||||
PM D2 post-op | ||||
AM D3 post-op | ||||
PM D3 post-op | ||||
NRS on mobilisation (0–10) | AM D1 post-op | |||
PM D1 post-op | ||||
AM D2 post-op | ||||
PM D2 post-op | ||||
AM D3 post-op | ||||
PM D3 post-op | ||||
Total morphine consumption | D0 post-op | |||
D1 post-op | ||||
D2 post-op | ||||
D3 post-op | ||||
|
||||
Wongyingsinn et al. [ |
Canada | NRS at rest (0–10) | 24 hours post-op | Thoracic epidural block |
48 hours post-op | ||||
72 hours post-op | ||||
NRS on walking (0–10) | 24 hours post-op | |||
48 hours post-op | ||||
72 hours post-op | ||||
NRS on coughing (0–10) | 24 hours post-op | |||
48 hours post-op | ||||
72 hours post-op | ||||
|
||||
YaDeau et al. [ |
USA | NRS at rest (0–10) | 30 min post-op | Lumbar plexus block |
1 hour post-op | ||||
2 hours post-op | ||||
3 hour post-op | ||||
4 hours post-op | ||||
24 hours post-op | ||||
NRS on movement (0–10) | 30 min post-op | |||
1 hour post-op | ||||
2 hours post-op | ||||
3 hour post-op | ||||
4 hours post-op | ||||
24 hours post-op | ||||
|
||||
Zhai et al. [ |
Not stated | NRS at rest (0–10) | Before block | Interscalene brachial plexus block |
Right before discharge from PACU | ||||
4 hours after block | ||||
8 hours after block | ||||
24 hours after block | ||||
Worst NRS (0–10) | 24 hours after block | |||
Time of first shoulder pain |
D0 post-op = Day 0 postoperatively; D1 post-op = Day 1 postoperatively; D2 post-op = Day 2 postoperatively; D3 post-op = Day 3 postoperatively; D4 post-op = Day 4 postoperatively; D5 post-op = Day 5 postoperatively; D6 post-op = Day 6 postoperatively; D7 post-op = Day 7 postoperatively; min = minutes; NRS = numeric (verbal) rating scale (0 = no pain to 10 = worst imaginable pain); VAS = visual analogue scale (0 mm = no pain to 100 mm = worst imaginable pain); APS-POQ-R = American Pain Society Patient Outcome Questionnaire Revised; WOMAC score = Western Ontario and McMaster Universities Osteoarthritis Index (5 pain questions included) OA specific; Oxford Knee Score 12-item knee questionnaire on pain; for measurement tool, “not stated” = whether pain score recorded at rest or on movement not stated in methods.
Summary of pain outcomes reported in included studies.
Pain outcome | No. of studies utilising outcome | Studies |
---|---|---|
VAS | 11 | Andersen et al. [ |
|
||
VAS on a specified activity | 1 | Thybo et al. [ |
|
||
Time to VAS 3 cm | 1 | Andersen et al. [ |
|
||
NRS at rest | 10 | Ambrosoli et al. [ |
|
||
NRS on activity | 9 | Ambrosoli et al. [ |
|
||
Maximum NRS score | 3 | Hamdani et al. [ |
|
||
Average NRS | 1 | Hamdani et al. [ |
|
||
Analgesic consumption | 7 | Bharti et al. [ |
|
||
Opioid consumption | 16 | Andersen et al. [ |
|
||
Time to 1st pain | 2 | Salviz et al. [ |
|
||
Time to 1st analgesic request | 6 | Karthikeyan et al. [ |
|
||
Time to 1st opioid request | 1 | Diakomi et al. [ |
|
||
Sleep disturbance | 2 | Ambrosoli et al. [ |
|
||
WOMAC | 1 | Wegener et al. [ |
|
||
APS-POQ-R | 1 | Elkassabany et al. [ |
NRS = numerical reported score (verbal; out of 10); VAS = visual analogue scale; APS-POQ-R = American Pain Society Patient Outcome Questionnaire; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.
Risk of bias assessment in included studies.
Fifteen different outcome measures in total were used in the 31 included studies to assess postoperative pain. The outcome measures utilised in the included studies are summarised in Table
Time of measurement of pain outcomes also varied with a total of 51 different time points utilised in the 31 studies (Table
A variety of nerve blocks were studied (16 in total), which are summarised in Table
Summary of regional techniques investigated in included studies.
Blocks studied | Number of studies | Studies |
---|---|---|
Supraclavicular | 2 | Subramanyam et al. [ |
|
||
Interscalene | 5 | Bengisun et al. [ |
|
||
Pectoral | 1 | Kulhari et al. [ |
|
||
Serratus-intercostal | 1 | Kim et al. [ |
|
||
Fascia iliaca | 1 | Diakomi et al. [ |
|
||
Femoral | 6 | Sato et al. [ |
|
||
Sciatic | 4 | Sato et al. [ |
|
||
Adductor | 1 | Sawhney et al. [ |
|
||
Saphenous | 1 | Andersen et al. [ |
|
||
Cervical plexus | 2 | Sindjelic et al. [ |
|
||
Lumbar plexus | 2 | YaDeau et al. [ |
|
||
Thoracic epidural | 1 | Wongyingsinn et al. [ |
|
||
Spinal | 1 | Boussofara et al. [ |
|
||
Interscalene catheter | 3 | Hamdani et al. [ |
|
||
Popliteal catheter | 2 | Capdevilla et al. [ |
|
||
Sciatic catheter | 1 | Ambrosoli et al. [ |
Twelve out of the 31 included studies (39%) used an independent or blinded assessor or independent assessment (i.e., postal survey) to assess patients’ pain [
All but two of the included studies focused on acute pain outcomes. Choi et al. assessed pain outcomes of acute and chronic pain [
This systematic review demonstrates that postoperative pain in regional anesthesia RCTs is reported inconsistently. The 31 studies included in this review utilised 15 different types of postoperative pain outcomes, measured at 51 different time points. Therefore at present, there appears to be multiple analyses of different nerve blocks in different centers using different acute pain outcome measures.
Heterogeneity in pain outcomes chosen in the included studies was high. One of the difficulties in deciding which pain outcomes to study in regional anesthesia trials is that there is no reliable method of
The visual analogue scale (VAS) is a widely used tool to assess postoperative pain. It is considered by some to be more sensitive to fine changes in pain score than numerical scales and four point scales [
Total opioid consumption over the study period (excluding daily and cumulative opioid consumption) was another popular outcome choice, which was utilised in 12 of the 31 studies reporting postoperative pain in this review. This outcome can be interpreted in different ways. A higher total opioid consumption value over a study period is presumed to indicate a higher pain state, necessitating requirement for supplemental opioid-based analgesia. Total opioid consumption could also reflect average pain scores (either NRS or VAS), with higher scores indicating greater opioid requirement. The psychological factors involved in patients requesting additional analgesia warrant further consideration. This involves evaluation of anticipated pain outcome with and without further analgesia, and in order for the request to be made, the patient must feel the treatment of pain outweighs the potential risk of side effects from the drug. This has been shown to be a key decision-making factor when patients are in pain [
Regional anesthesia is gaining popularity, partly due to improvements in safety and success attributed to ultrasound-guided techniques [
Adequate assessment of pain, using validated tools appropriate to the population or individual, is an essential prerequisite of successful pain management. It has been shown in many countries that inadequate pain assessment is common, with resultant failings in management of pain [
The core outcome set for chronic pain studies may help researchers decide which outcomes to utilize in future regional anesthesia pain studies. A core outcome set of six outcomes for chronic pain was formalised in 2005 by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) group [
When deciding what should be a “core outcome set,” one must consider if there is an
This review does have some limitations. Restricting included RCTs to English language studies may have reduced the number of clinically useful studies analysed. Additionally, the restriction to the top 20 impact factor journals may not reflect the outcome measures utilised in the majority of regional anesthesia studies. This did however serve as a marker of study quality and peer review, which we felt was required in this review. However, there are always risks inherent in limiting groups to be studied. The year of publication of included studies is important to note, and established blocks such as femoral nerve blocks may have already been extensively studied prior to 2005. Use of ultrasound guidance may have made some small differences to pain assessment outcome choice and the debate surrounding adductor canal versus femoral nerve block may continue; however, 2005 to 2017 is a relatively short period of time for major changes in clinical practice to have occurred. We limited the search to articles published over this 12-year period as our intention was to provide the reader with information regarding regional anesthesia studies that would be most relevant to current practice. Finally, although we have attempted to locate all relevant articles by using a robust search methodology, it is possible that with a review of this size, some relevant articles may have been missed. Furthermore, since these studies explore different peripheral nerve and plexus blocks, this may make it more difficult to derive an implied core outcome set from the included group of studies. We appreciate that different surgeries have different temporal pain profiles. Some surgeries for example may peak in pain immediately after surgery, whereas others may have pain that peaks when the nerve block wears off or during days following surgery. However, despite the apparent heterogeneity among the included studies, the vast majority of the RCTs included utilised generic outcomes and only one study used a scoring system specific to the type of surgery performed (the Western Ontario and McMasters Universities Osteoarthritis Index) [
In summary, this robust review of the postoperative pain outcomes used in regional anesthesia RCTs between 2005 and 2017 demonstrates significant heterogeneity in choice of outcomes and times of measurements utilised. These findings represent a starting point for further work into developing a core outcome set for future regional anesthesia studies.
The basic components of the search were as follows: Postoperative pain (ti.ab) AND regional anaesthesia (ti.ab) AND randomised controlled trial (ti.ab) AND top 20 impact factor journals (j.n.) [limited to 2005–2017]
These were the search terms used in OpenAthens to formulate the final search: EMBASE, Medline, CINAHL; (((postoperative pain adj4 pain EMBASE, Medline, CINAHAL; (((post-surgical adj4 pain EMBASE, Medline, CINAHL; (((“pain-relief after surgery”) OR (“pain following surg”) OR (“pain control after”))) ti.ab EMBASE, Medline, CINAHL; (((“post surg EMBASE, Medline, CINAHL; (((pain EMBASE, Medline, CINAHL; (((analgesi 1 OR 2 OR 3 OR 4 OR 5 OR 6 “An?esthesia, Conduction” ti.ab “An?esthesia, Spinal” ti.ab “Analgesi, Epidural” ti.ab “An?esthesia, Epidural” ti.ab “An?esthesia, Caudal” ti.ab “Nerve Block” ti.ab “regional an?esthesia” ti.ab “conduction an?esthesia” ti.ab “spinal block” ti.ab “Epidural block” ti.ab “epidural an?esthesia” ti.ab “plexus block” ti.ab (plexus AND block) ti.ab (bier AND block) ti.ab 8 OR 9 OR 10 OR 11 OR 12 OR 13 OR 14 OR 15 OR 16 OR 17 OR 18 OR 19 OR 20 OR 21 (“randomi?ed controlled trial”) OR (“randomi?ed trial”) OR (“controlled trial”) ti.ab EMBASE, Medline, CINAHL; (“anesthesiology” OR “pain” OR “british journal of anaesthesia” OR “pain physician”OR “anesthesia and analgesia” OR “anaesthesia” OR “regional anesthesia and pain medicine” OR “journal of neurosurgical anesthesia” OR “european journal of anaesthesia” OR “european journal of pain” OR “canadian journal of anesthesia” OR “clinical journal of pain” OR “pain practice” OR “acta anaesthesia scandinavia” OR “Minerva anesthesiology” OR “journal of clinical monitoring and computing” OR “current opinion anesthesiology” OR “journal of cardiothoracic and vascular anaesthesia” OR “BMC anesthesiology”).jn 7 AND 22 AND 23 AND 24 [Limit to: Publication Year 2005–2017]
These are the current impact factors of all the top international anesthesia journals as of 21st October 2015 [
Rank | Impact factor | |
|
||
1 | Anesthesiology | 5.879 |
2 | Pain | 5.213 |
3 | British Journal of Anaesthesia | 4.853 |
4 | Pain physician | 3.542 |
5 | Anesthesia and Analgesia | 3.472 |
6 | Anaesthesia | 3.382 |
7 | Regional Anaesthesia and Pain management | 3.089 |
8 | Journal of Neurosurgical Anaesthesia | 2.99 |
9 | European Journal of Anaesthesia | 2.942 |
10 | European Journal of Pain | 2.928 |
11 | Canadian Journal of Anesthesia | 2.527 |
12 | Clinical Journal of Pain | 2.527 |
13 | Pain Practice | 2.361 |
14 | Acta Anaesthesia Scandinavia | 2.322 |
15 | Minerva Anesthesiology | 2.134 |
16 | Journal of Clinical Monitoring and Computing | 1.985 |
17 | Current Opinion Anesthesiology | 1.979 |
18 |
|
1.85 |
19 |
|
1.598 |
20 | Journal of Cardiothoracic and Vascular Anaesthesia | 1.463 |
21 | BMC Anesthesiology | 1.375 |
22 | Anaesthesia and Intensive Care | 1.296 |
No study-related external funding or competing interests declared.
All authors are responsible for data collection and data analysis and wrote the manuscript.