Anesthesia Clinical Reference Group

Time: Tuesday, July 25, 2023 19:00 - 20:00 UTC / 20:00 - 21:00 UK / 15:00 - 16:00 ET

Or Telephone:

+1 646 518 9805 (US Toll)
+44 203 481 5237 (GB Toll)
+1 587 328 1099 (CA Toll)

International numbers available:

1Introductions and Apologies


Matters arising from the previous meeting notes

2023-04-04 Anesthesia CRG London F2F Meeting

3SNOMED Update
Business Meeting: Friday Oct 20 - Weds Oct 25
Expo: Weds Oct 25 - Fri Oct 27
IG notes the agenda for Atlanta is in development, Speakers have been arranged. There is lots of discussion regarding the use of specialty registries and of networking them together, Registration is open. PM expects that the Anesthesia group may meet virtually.
4Local Anesthetic question

Longstanding question regardng local anesthetic

Is concept 265778005 |Local anesthetic nerve block (procedure)| a duplicate of 56333001 |Nerve block (procedure)| ?

Reference "The obturator nerve branches into the obturator canal; therefore, local anesthetic spread into the obturator canal predicts the success of the obturator nerve block (ONB)" This paper discusses a nerve block, and clearly assumes it uses a local anesthetic.,decrease%20inflammation%20in%20that%20area. "A nerve block is an anesthetic and/or anti-inflammatory injection targeted toward a certain nerve or group of nerves to treat pain. The purpose of the injection is to "turn off" a pain signal coming from a specific location in the body or to decrease inflammation in that area"

This site explains a nerve block as an injection to turn off a pain signal from a specific location in the body. Indeed, how could the effect of blocking a particular nerve not be local, or localized anyway? Obviously the effect can be (quite a bit) downstream, but it's not going to be generic the way an aspirin is. Third piece of evidence: run the ECL query < 265778005 |Local anesthetic nerve block (procedure)| and you find dozens of concepts without local in the FSN, e.g. 764912007 |Obturator nerve block using fluoroscopic guidance (procedure)|. If there is a clear difference, then the modelling is inconsistent.

See also:

Comments from PM: 

Agree with Steven that "nerve block" can mean inactivation of the nerve through methods other than local anesthesia.  However, in the context of my anesthesiology procedures and anesthesiology research, "nerve block" always refers to a "local anesthesia nerve block."  Among, say, pain specialists or interventional radiologists "nerve block" can refer to cryo, RF, phenol, or other means of nerve inactivation.  "cryo nerve block" on google brings up links to several healthcare institutions discussing cryoablation of nerves.

Wikipedia definition: "Nerve block or regional nerve blockade is any deliberate interruption of signals traveling along a nerve, often for the purpose of pain relief."  Article has subheadings for "local anesthetic nerve block", "Neurolytic block", "Neurectomy", and "Regional blocks".

After discussion

Noted that arrangement of concepts is not very logical

"Nerve block" is not a duplicate of "local anesthesia nerve block"

5IASP Termiinology

Jane Millar has been approached by a member country to discuss the possibility of linking SNOMED to terminology used by the IASP (International Association for the Study of Pain). Definbition of pain by the IASP has recently been modified. Extent of "linkage" and copyright considerations would need to be clarified.

The Revised IASP definition of pain: concepts, challenges, and compromises - PMC (

Terminology | International Association for the Study of Pain (

IG: will produce briefing paper to continue discussion

6Work Plan and Outreach (e.g. to SCATA and RCoA)
  • Agree targeted outreach (see 23/04 notes for list of potential organisations)
  • Facilitated discussion to agree focus of workplan

Dates of next meeting

Tuesday September 26, 2023

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  1. Local anesthesia question–this is a very big topic that needs a meeting on its own.  With regards to nerve blocks-nerves can be blocked temporarily (less than 24 hours or so with a local anesthetic), nerves can be blocked for a intermediate term, say weeks to months with a cryoprobe or similar device, or permanently (months to years) with a neurolytic agent such as phenol.

    The definition is incorrect in many ways.  It ignores 2 of the 3 scenarios just mentioned in my paragraph above, and secondly an anti-inflammatory injection without a local anesthetic mixed with it is not a nerve block.

    So for many reason the request Request is to inactivate 265778005 |Local anesthetic nerve block (procedure)| as duplicate of 56333001 |Nerve block (procedure)| should be denied.

    What should be considered is making 265778005 |Local anesthetic nerve block (procedure)|, a child of 56333001 |Nerve block (procedure)| as is the case with 277842006 | Neurolytic autonomic nerve block (procedure) |, but oh no 278739006 | Neurolytic sympathetic nerve block (procedure) | is modelled differently than 277842006 | Neurolytic autonomic nerve block (procedure) |

    I can't find the code for  procedure cryogenic nerve block which we have discussed in the past.

    To complicate matters there is also 26402001 | Nerve block anesthesia (procedure) |  A child of procedure and 

     274497003 |Nerve injection (procedure)| which is not ideal as we generally do "peri-nerve injections"  or "around nerve" and not into the nerve unless we are trying to destroy it!

    There are currently 143 nerve block procedure codes, many (if not most) mentioning local anesthesia and not mentioning neurolytic or cryogenic blocks. 

    It should be noted that 11055001 | Injection of anesthetic agent into facial nerve (procedure) | is wrong (terrible) as a person should never inject a local anesthetic into a nerve unless they are trying to destroy the nerve! Local anesthetics are injected around the nerve.  This code was probably made up by a Dentist or plastic surgeon! LOL

    There is also 33310001 | Therapeutic block anesthesia (procedure) | I assume this includes the cryogenic and neurolytic blocks and blocks with a mixture of a local anesthetic and anti-inflammatory agent

    It would be nice if someone taught me how to download the SNOMED dictionary into Microsoft Access or as a Postgres or other tool for doing queries that I can put into excel to analyse.

    1. Steven Dain 

      There is a project here that can load SNOMED into Postgres or MySQL.

      Kai Kewley ( may be able to help you if you have general problems. 

  2. Steven Dain  Re: how to download the SNOMED dictionary into Microsoft Access 

    If you're from the UK or another SNOMED Member Country, you can download it preloaded into MS Access from here: SNOMED CT UK Data Migration Workbench - TRUD ( - though this release includes the entire UK Edition and not just the International Core data.

    This download includes an Excel AddOn that adds many useful user defined terminology lookup functions to your local Excel installation, driven off the Access data in the background.