Development and Validation of a Consensus-Based Checklist for Regional Anesthesia: The LRA Checklist as a Tool for Safety, Standardization, and Value-Based Care

Background: Regional anesthesia is a fundamental aspect of contemporary perioperative care. However, variability in practice, incomplete documentation, and inconsistent safety protocols continue to pose preventable risks. Although there are international checklist models for regional anesthesia and perioperative safety such as those developed by ASRA, ESAIC, and the WHO, Italy does not have a nationally endorsed checklist that is consensus-based and specifically tailored to local terminology, workflows, and legal requirements. Methods: To address this gap, we developed an evidence-based Locoregional Anesthesia Checklist (LRA Checklist) using established frameworks for healthcare checklist design. The development process included a needs assessment through a national survey of ESRA Italy members, a review of existing models, item drafting, expert consensus, and endorsement by the Board. We assessed content validity through a modified Delphi process involving 15 experts from the ESRA Italian Chapter Board. Additionally, we created a theoretical impact model to estimate the potential organizational and economic effects of implementing the checklist, using baseline institutional parameters. Results: Consensus was achieved for all checklist domains after two Delphi rounds, with minor edits to improve clarity, usability, and clinical relevance. The theoretical model indicates that adopting checklists may help reduce preventable complications, improve workflow, enhance documentation and traceability, and provide overall benefits to institutions in various scenarios. Conclusions: In conclusion, the LRA Checklist is a structured, consensus-based tool tailored for the Italian context, aimed at promoting safer and more standardized practices in regional anesthesia. To our knowledge, no prior Italian national consensus or checklist specifically dedicated to regional anesthesia has been formally published. Prospective multicenter studies are necessary to confirm its effectiveness in real-world settings and to quantify both clinical and economic outcomes.