Pain Distraction During Awake Major Colorectal Surgery: Supporting Patients Beyond the COVID-19 Era. Preliminary Findings.

Andrea Romanzi,Sabrina De Rango,Barbara Vignati,Gaetano Gallo,Alberto Vannelli

doi:10.3389/fsurg.2021.754059

Abstract

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, hospitals rapidly ran out of intensive care beds. Because minimally invasive surgery and general anaesthesia are both aerosol-generating procedures, their use has become controversial. We report a case series of awake undelayable colorectal surgeries which, innovatively, took advantage of intraoperative pain distraction. Moreover, we describe our frugal solution to social distancing in psychological support of inpatients.Methods: Between October 2020 and February 2021, five patients underwent acute-care colorectal surgery under locoregional anaesthesia in our department. A 3D mobile theatre (3DMT) was used during the operation to distract the patients from pain. Vital signs, pain intensity, ergonomic comfort/discomfort, sense of presence and distress were intraoperatively monitored. A postoperative “cuddle delivery” service was instituted: video messages from relatives and close friends were delivered daily to the patient through the 3DMT. Emotional effects were investigated through clinical interviews conducted by a psychologist at our hospital.Results: Both intraoperative and postoperative pain were always well controlled. Conversion to general anaesthesia and postoperative intensive support/monitoring were never necessary. The “cuddle delivery” initiative helped patients fill the emotional gap created by the strict containment measures implemented inside the hospital, distracting them from emotional anxiety and physical pain.Conclusions: During the next phase of the COVID-19 pandemic and even after the COVID-19 era, awake laparotomy under locoregional anaesthesia may be a crucial option for delivering acute-care surgery to selected patients when intensive care beds are unavailable and postponing surgery is unacceptable. We also introduce a new modality for the provision of emotional support during postoperative inpatient care as a countermeasure to the restrictions imposed by social distancing measures.

Highlights

During the coronavirus disease 2019 (COVID-19) pandemic, hospitals rapidly ran out of intensive care beds
minimally invasive surgery (MIS) and general anaesthesia (GA) are both aerosol-generating medical procedures (AGMPs), and their use has become controversial during the pandemic because they could contribute to the spread of pathogens inside operating theatres [2, 3]
One week prior to each surgery, on the day on which the preadmission tests were performed, both the surgical procedure and approach to anaesthesia were explained to the patients during a multidisciplinary meeting

Summary

Introduction

During the coronavirus disease 2019 (COVID-19) pandemic, hospitals rapidly ran out of intensive care beds. Because minimally invasive surgery and general anaesthesia are both aerosol-generating procedures, their use has become controversial. During the coronavirus disease 2019 (COVID-19) pandemic, allocating intensive care beds to patients needing acute-care surgery became very difficult. Major abdominal surgeries are generally carried out with minimally invasive surgery (MIS) under general anaesthesia (GA). Frail patients may require intensive postoperative monitoring/support, which cannot be provided when resources are scarce [4]. In such a unique context, performing open abdominal surgery under locoregional anaesthesia (LA) helped us perform acute-care surgery in selected patients during the COVID-19 pandemic

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