Clinical utility of randomized controlled trials of regional anesthesia for lower-extremity surgery: a systematic review

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.

To evaluate the clinical usefulness and transparency of RCTs investigating RA interventions for lower extremity surgeries, using the van 't Hooft et al framework.

Embase/MEDLINE were searched for RCTs (2014-2024) 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.

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<0.001) and was greater in hospital-funded, self-funded, and higher-impact journals.