The use of continuous perineural catheters and other practices to optimize regional anesthesia in COVID-19 patients
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CORRESPONDENCE
The use of continuous perineural catheters and other practices to optimize regional anesthesia in COVID-19 patients John J. Finneran IV, MD . Engy T. Said, MD . Brian P. Curran, MD . Rodney A. Gabriel, MD, MAS (Clinical Research)
Received: 8 June 2020 / Accepted: 8 June 2020 Ó Canadian Anesthesiologists’ Society 2020
To the Editor, As anesthesiologists, we are on the front line of the fight against coronavirus disease (COVID-19), whether in the intensive care unit, operating room, or elsewhere in the hospital. Given the highly contagious nature of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus via contact, droplets, and aerosols, it is critically important for anesthesiologists to have proper personal protective equipment (PPE) and for healthcare systems to create protocols to minimize exposure.1 In the operating room, regional anesthesia has the potential to allow providers to avoid the aerosol generation associated with general anesthesia and its requisite bag mask ventilation, airway suctioning, and endotracheal intubation.2 Regional anesthesia, therefore, has the potential to decrease SARSCoV-2 spread to healthcare workers, in addition to the many other benefits nerve blocks offer to surgical patients.3 Based on our experience performing regional anesthesia in COVID-19 patients, we recommend performing all blocks in the patient’s isolation room before transportation to the perioperative area. Additionally, we recommend continuous peripheral nerve blocks for all COVID-19 patients expected to have multiple surgeries or significant prolonged postoperative pain. Some authors have recommended bringing COVID-19 patients to the operating room for the nerve block to be performed, waiting for the block to fully set-up, and then checking the block with ice prior to proceeding with surgery.2 We feel that this not only unnecessarily increases J. J. Finneran IV, MD (&) E. T. Said, MD B. P. Curran, MD R. A. Gabriel, MD, MAS (Clinical Research) Department of Anesthesiology, University of California San Diego, San Diego, CA, USA e-mail: [email protected]
the operating room time but also potentially increases exposure to personnel in the operating room without providing significant benefit. In contrast, our practice is to perform blocks in the patient’s own isolation room using standard monitors4 and limited sedation with intravenous midazolam and fentanyl, allowing us to assess adequacy of the block and then proceed to the operating room. This practice offers the benefits of ensuring the block will work adequately for surgery while minimizing time in the operating room and exposure of the perioperative staff. When performing blocks on COVID-19 patients, the most experienced regional anesthesiologist performs the block and should utilize the Centers for Disease Control and Prevention recommended PPE.5 This ideally is done without anyone else in the room in order to limit the potential SARS-CoV-2 exposure. If assistance is needed with catheter placement, sedation, or monit
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