Review and practical recommendations for peripheral nerve block during Coronavirus Disease-2019 pandemic

Abstract

Coronavirus disease-2019 (COVID-19) was announced as a global pandemic by the World Health Organization on March 11, 2020 due to its rapid spread and multinational involvement. Operating room preparedness in these times should encompass increased vigilance, protective measures, and alternative procedures in an effort to mitigate the spread from a proven or suspected case. Specifically, by reducing aerosol-generating procedures as in general anesthesia, anesthesiologists can decrease exposure to patient's respiratory secretions and transmission of virus to the health-care professional and other patients. The Interoperability Standards Advisory in its advisory has also recommended regional anesthesia over general anesthesia as one of the steps that can reduce aerosol spread. Further, to restrict airway manipulation, peripheral nerve blocks (PNB) should be considered whenever possible in suspected or confirmed cases of COVID-19 undergoing surgery. PNB has the advantage of maintenance of respiratory functions, prevention of aerosolization, and so preventing viral transmission. This article explores the practical information and suggested measures for conducting PNB in COVID-19 patients with suggestions toward resource planning, clinical environment modification, equipment preparation, supply of drugs, choosing of correct personal protective equipment, safe PNB procedures, anesthesia monitoring, and postanesthetic care. By addressing these issues, infection control during anesthesia can be achieved and which is essential in the present era with emerging infection and novel pathogens such as coronavirus 2 causing the severe acute respiratory syndrome. Thus, framing a structured protocol for PNB among these patients is essential for the best perioperative outcome.