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Perioperative Pain Management Using Local and Regional Analgesia for Cardiothoracic Surgeries, Mastectomy, and Abdominal Surgeries in Adults and Children

- Evidence Assessment

According to WHO Handbook for Guidelines, we used the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach to assess the quality of a body of evidence, develop and report recommendations. GRADE methods are used by WHO because these represent internationally agreed standards for making transparent recommendations.

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Unrestricted materials of the standard disclaimers for WHO publications are used.

Detailed GRADE information is available on the following sites:

•           GRADE working group: https://www.gradeworkinggroup.org/

•           GRADE online training modules: http://cebgrade.mcmaster.ca/

Quality Definition Implications

Evidence is categorized as High, Moderate, Low and Very low.

Table 1: Quality and Significance of the Four Levels of Evidence in GRADE:

Quality

 

Definition

Implications

High

The guideline development group is very confident that the true effect lies close to that of the estimate of the effect.

 

Further research is very unlikely to change confidence in the estimate of effect.

 

Moderate

The guideline development group is moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

 

Further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate.

 

Low

Confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the true effect.

Further research is very likely to have an important impact on confidence in the estimate of effect and is unlikely to change the estimate.

 

Very low

The group has very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of the effect.

 

Any estimate of effect is very uncertain.