Published reports of RCTs provide evidence to formulate limited recommendations regarding optimal approaches and techniques for brachial plexus anesthesia. Further well-designed and meticulously executed RCTs are warranted, particularly in light of new techniques involving ultrasound or combining neurostimulation and echoguidance.

risk of not implementing the plan on a timely basis. The alternative is to implement a plan with a commitment to flexibility and responsiveness to new information. That is what we have done. As indicated in our article, we hope that our study will provide an "incentive" for a reasonable, scholarly discourse based on data, rather than opinion and fear, regarding the conditions under which academic departments should implement incentive-based systems (and which one).