May regional anesthesia be a better choice for the COVID-19 pandemic?
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(2020) 12:44
LETTER TO THE EDITOR
Ain-Shams Journal of Anesthesiology
Open Access
May regional anesthesia be a better choice for the COVID-19 pandemic? Bahadir Ciftci* , Mursel Ekinci and Yunus Oktay Atalay To the Editor; The novel coronavirus disease 2019 (COVID-19) is a global pandemic and threat all over the world. The first cases were seen in, Wuhan, China, in December 2019 (Chen et al. 2020a). This novel coronavirus was identified from the throat sample of a patient and was named 2019-nCoV by the WHO. It has spread rapidly, and now, there are more than 2.3 million reported cases and 160,000 deaths worldwide. Anesthesiologists are the frontline warriors both in the intensive care units and operation rooms during this pandemic. There is an important question for us: which anesthesia technique should we choose for these patients? In this report, we would like to share our regional anesthesia experiences in patients under investigation for COVID-19 that underwent surgery. Written informed consent was obtained from the patients. According to practice recommendations on neuraxial anesthesia and peripheral nerve blocks during the COVID-19 by the American Society of Regional Anesthesia and Pain Medicine (ASRA) and European Society of Regional Anesthesia and Pain Therapy (ESRA) (https://www.asra.com/page/2905/practice-recommendations-on-neuraxial-anesthesia-and-peripheral-nerveblocks-dur), we preferred regional anesthesia over general anesthesia for these patients to reduce the need for airway manipulation. The blocks were performed in the operating room prepared for just COVID-19 or COVID19-suspected patients. The drugs and equipment were all prepared in another clean room. Although neuraxial anesthesia and peripheral nerve blocks are not aerosolgenerating procedures, we donned personal protective equipment, and the patients wore surgical masks. To minimize the need for conversion to general anesthesia, * Correspondence: [email protected]; [email protected] Department of Anesthesiology and Reanimation, Mega Medipol University Hospital, Istanbul Medipol University, School of Medicine, 34040, Bagcilar, Istanbul, Turkey
all the blocks were performed by the most experienced anesthetist. The first case was a 38-year-old man who underwent wrist fracture operation. He had cough and sub-febrile fever (37.8 °C). After covering ultrasound transducer with plastic covers, ultrasound-guided infraclavicular block was performed. The second case was a 63-year-old man who underwent proximal femur fracture surgery. He had cough, fever (38.2 °C), and physical examination of bilateral crepitus at the base of the lungs. After ruling out thrombocytopenia, we performed spinal anesthesia at the level of L4–L5 intervertebral space. The third case was a 25-year-old cesarean section case. Her physical examination and vital signs were normal; however, her husband was COVID-19 positive. Her thrombocyte level was normal, and we performed her spinal anesthesia at the level of L3–L4 intervertebral space. The parturient had hypotension
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