Practice Of Regional Anesthesia Research Articles

Point-of-care Ultrasound (POCUS) for the Regional Anesthesiologist

Abstract Purpose of Review Application of ultrasound in clinical anesthesia practice extends beyond regional anesthesia. In this review, we have discussed other point-of-care applications of ultrasound in perioperative care and anesthetic management with emphasis on regional anesthesia practice. Recent Findings Point-of-care ultrasound (POCUS) for anesthesiologists has gained widespread interest and popularity. Recent literature has highlighted multiple perioperative POCUS applications on various organ systems and their benefits. In this section, we have analyzed the recent available data and evidence for perioperative POCUS for airway, gastric contents and trauma, its applications, benefits, and limitations in perioperative medicine. Summary Perioperative POCUS skill is a natural extension of ultrasound guided regional anesthesia. Utilizing POCUS in the perioperative period would accelerate the level of appropriate care, safety, and improve outcomes. More anesthesiologists embracing POCUS would enhance patient care in a timely fashion. POCUS in regional anesthesia practice, including ambulatory centers, can be valuable in avoiding delay or cancellation of surgeries and improving patient satisfaction.

A comprehensive retrospective analysis of interfascial plane blocks and peripheral nerve blocks at a tertiary research hospital: Single center experience

Aim: This study aimed to analyze regional anesthesia practices at a tertiary research hospital as a single center during a one-year period (January 2022 to January 2023).Materials: Data on over 2,000 nerve blocks were retrospectively reviewed, including: type of nerve block performed (peripheral nerve vs. fascial plane, location of block (upper vs. lower extremity), purpose of block (anesthesia or analgesia) and outcomes.Method: Data was analyzed to assess trends in block utilization, identify preferred block types and locations, and compare the use of peripheral nerve blocks versus fascial plane blocks for anesthesia and analgesia. Additionally, the potential opioid-sparing benefits of fascial plane blocks were evaluated.Results: The analysis revealed a notable shift towards fascial plane blocks (61%) compared to peripheral nerve blocks (39%). Lower extremity blocks were more common (56%), with sciatic, saphenous, and femoral nerve blocks being the most frequently used. In the upper extremity (44%), infraclavicular and interscalene brachial plexus blocks dominated. Interestingly, fascial plane blocks were primarily employed for analgesia, while peripheral nerve blocks served both anesthetic and analgesic purposes. The study identified opioid-sparing advantages associated with fascial plane blocks, highlighting their potential role in multimodal pain management strategies.Conclusions: Based on these findings, areas for improvement in regional anesthesia practices were identified. Educational programs will be adjusted accordingly. Future research will delve deeper into patient characteristics, block selection rationale, and incorporate patient-reported outcomes alongside opioid consumption and pain scores. This study serves as a foundation for future enhancements in regional anesthesia practices, aiming to optimize patient care and outcomes.

Comparison of the analgesic effects of different bupivacaine concentrations in continuous femoral block after total knee arthroplasty surgery

Aim: In regional anesthesia practice, anesthesists’ goal must be to use the lowest effective concentration of local anesthetics to provide sufficient pain relief while minimizing side effects and complications. This study was designed to compare the analgesic efficacy of two different concentrations of bupivacaine (0.125% and 0.1%) in continuous femoral block for postoperative analgesia.Method: In this study, fifty patients were enrolled, all of whom underwent femoral nerve block catheterization. The block procedure involved the administration of 30ml of bupivacaine solution at a concentration of 0.25%. Following a thirty-minute interval post-block application, patients underwent knee surgery under general anesthesia. During the closure of subcutaneous tissues, an additional 10ml of bupivacaine solution was injected through the catheter. Two groups were formed based on the concentration of the solution administered: Group(0.125%) received bupivacaine at a concentration of 0.125%, while Group(0.1%) received it at a concentration of 0.1%. Subsequently, upon arrival at the postoperative care unit, infusion through the catheter commenced at a rate of 10ml/h-1, maintaining the same concentrations for both groups. In addition to the nerve block, all patients were provided with intravenous Patient Controlled Analgesia (PCA) devices containing morphine for pain management. Throughout the postoperative period, sensory and motor block levels, Numerical Rating Scale (NRS) values for static and dynamic pain assessment, total morphine consumption, morphine demand, as well as any observed side effects and complications, were meticulously recorded for analysis.Results: Postoperatively the NRSstatic values at 24th and 48th hours and NRSdynamic values at the 24th hour were higher in Group(0.1%) and it was statistically significant(p<0,007). And at 48th hour, morphine consumption was significantly higher in Group(0.1%) (p<0,05).Conclusions: In our study, all patients across both experimental groups initially experienced satisfactory analgesia. However, within the 24-hour postoperative period, Group(0.1%) exhibited a decline in the quality of analgesia, necessitating increased utilization of rescue analgesics. This escalation in rescue analgesic use was associated with a higher incidence of adverse effects and reduced patient comfort levels within this group. Consequently, our findings indicate that the 0.125% concentration of bupivacaine yielded superior efficacy compared to the 0.1% concentration in the context of continuous femoral block administration.

Regional anaesthesia practice in public hospitals in Botswana: A cross-sectional study.

Little is known about the regional anesthesia practice in low resources settings (LRS). The aim of this study was to describe the regional anesthesia capacity, characteristics of regional anesthesia practice, and challenges and solutions of practicing safe regional anesthesia in public hospitals in Botswana. This was a cross-sectional survey of anesthesia providers working in public hospitals in Botswana. A purposive sampling method of public hospitals was used to achieve representation of different hospital levels across Botswana. Paper-based questionnaires were sent to anesthesia providers from selected hospitals. Descriptive statistics were used for analysis. Questionnaires were distributed to 47 selected anesthesia providers from selected hospitals; 38 (80.9%) were returned. Most participants were nurse anesthetists and medical officers (57.8%). All hospitals perform spinal anesthesia; however, other regional techniques were performed by a small number of participants in one referral hospital. Most hospitals had adequate regional anesthesia drugs and sedation medications, however, most hospitals (except one referral hospital) lacked ultrasound machine and the regional anesthesia kit. The common challenges reported were lack of knowledge and skills, lack of equipment and supplies, and lack of hospital engagement and support. Some solutions were proposed such as regional anesthesia training and engaging the hospital management to get resources. The results of this study suggest that spinal anesthesia is the most common regional anesthesia technique performed by anesthesia providers working in public hospitals in Botswana followed by few upper limb blocks. However, most public hospitals lack enough training capacity, equipment, and supplies for regional anesthesia. More engagement of the hospital management, investment in regional anesthesia resources, and training are needed in order to improve the regional anesthesia capacity and provide safe surgery and anesthesia in Botswana.

Review of strategies to prevent infections related to ultrasound-guided nerve blocks and vascular access

Ultrasound guidance has become ubiquitous in the clinical practice of regional anesthesia and vascular access. Because the ultrasound transducer and an acoustic coupling medium (e.g. ultrasound gel) are applied directly to the patient’s body, the contact of a non-sterile ultrasound transducer with the site of intervention during the breach of the skin integrity by the needle carries the risk of infection transmission. Surprisingly, however, recommendations on how to prevent ultrasound-related outbreaks are often conflicting. With the increasing use of ultrasound in interventional procedures, such as vascular access, regional anesthesia, and pain medicine, the development of clear guidelines on how to prevent infection from patient to patient is essential for patient and operator safety. This review aims to provide a current understanding of the mechanisms and prevalence of infection transmission and to summarize the current recommendations for infectious precautions with interventional ultrasound. We also provide practically implementable and pragmatic recommendations for infectious precautions, based on the available information.

A survey about the practice of regional anesthesia in Manchester and Lancashire.

In 2021, the UK Royal College of Anaesthetists published an updated curriculum which outlines specific peripheral nerve blocks in which all anesthetists must achieve competency during their training. Little is known about which nerve blocks anesthetists in the UK can perform, nor which techniques they use to perform them. We conducted a survey of anesthetists in North West England to discover their experience in anesthesia, which nerve blocks they can perform, and which techniques they use to perform them. Overall, 195 responses were received. Seventy-nine respondents (44%) preferred to perform nerve blocks on anesthetized patients, 70 (40%) preferred to perform nerve blocks with the patient awake with no sedation. One hundred and thirty-seven (85%) respondents used ultrasound only to localize nerves when performing a block. Among consultant respondents, 21 (19%) were unable to perform any upper limb block, and 48 (44%) were unable to perform any block of the thorax, both are a required competency of trainees under the 2021 curriculum. Trainees may struggle to achieve the required competencies of the new curriculum given many consultants are also unable to perform them. A structured placement in regional anesthetic training in each stage of training could help improve the acquisition of skills and knowledge among trainees. Further studies are needed to assess the ability of anesthetists nationwide in regional anesthesia.

The efficacy of an anatomy and ultrasonography workshop on improving residents’ confidence and knowledge in regional anesthesia

BackgroundUltrasound Guided Regional Anesthesia (UGRA) has become the standard for regional anesthesia practice, but there is not a standardized educational approach for training residents. The objective of this study was to evaluate the efficacy of an UGRA workshop utilizing the theoretical framework of embodied cognition for anesthesiology residents.MethodsA workshop was developed consisting of didactics, scanning training on standardized patients (SPs) and anatomy reviews on prosected cadavers that focused on the most common UGRA procedures for the upper and lower extremity. At the beginning of the workshop and at the end of the workshop residents completed pre-test and pre-confidence surveys, as well as post-test and post-confidence surveys, respectively to assess the impact of the workshop.Results39 residents (100% of the possible residents) participated in the workshop in 2019. Residents’ confidence in identifying relevant anatomy for the most common UGRA procedures significantly increased in 13 of the 14 measurements. Residents’ knowledge gain was also statistically significant from the pre-test to post-test (20.13 ± 3.61 and 26.13 ± 2.34; p < .0001). The residents found the course overall to be very useful (4.90 ± 0.38) and in particular the cadaveric component was highly rated (4.74 ± 0.55).ConclusionsIn this study, we developed a workshop guided by the embodied cognition framework to aid in shortening the overall learning curve of UGRA for anesthesiology residents. Based on our results this workshop should be replicated by institutions that are hoping to decrease the learning curve associated with UGRA and increase residents’ confidence in identifying the relevant anatomy in UGRA nerve blocks.

48 Evaluation of Regional Anaesthesia Practice in Plastic Surgery; a Retrospective Cross-Sectional Study

Abstract Aim Our project aimed at assessing the regional anaesthesia practice in plastic surgery department Buckinghamshire trust and finding out ways to improve the service in collaboration with the anaesthesia team. Method It is a retrospective study associated with a questionnaire filled by plastic surgeons and anaesthetists to get the full picture behind the numbers. The study period was between 1/3/2022 and 23/5/2022 (12 weeks). Criteria of suitable candidates for regional block were put by the consultant anaesthetists. Results For 12 weeks, 1061 operations were performed by plastic surgeons. Local cases were excluded leaving 319 cases. Of the 319, 102 patients were suitable candidates for regional block after applying the criteria. However only 7 patients had their operations under regional block and the rest had general anaesthesia that could have been easily avoided. An online questionnaire was filled by both plastic surgeons and anaesthetists of different training level to find out the reasons behind the obvious preference of general over regional anaesthesia even if this was against the patients’ interest. Forty-four clinicians filled the questionnaire, among which was 23 plastic surgeons and 21 anaesthetists. The actual percentage of patients who were good candidates for RA but had GA instead is 93%. Conclusions The recommendations were in 5 main accesses which areProtocols and pathways for regional blocksMore training opportunities for anaesthetists on regional blocksProviding a separate block room in the hospitalBetter communication between surgeons and anaesthetistsPatient education about the benefits of regional blocks

The Advances and Utility of Artificial Intelligence and Robotics in Regional Anesthesia: An Overview of Recent Developments.

The integration of artificial intelligence (AI) and robotics in regional anesthesia has brought about transformative changes in acute pain management for surgical procedures. This review explores the evolving landscape of AI and robotics applications in regional anesthesia, outlining their potential benefits, challenges, and ethical considerations. AI-driven pain assessment, real-time guidance for needle placement during nerve blocks, and predictive modeling solutions for nerve blocks have the potential to enhance procedural precision and improve patient outcomes. Robotic technology aids in accurate needle insertion, reducing complications and improving pain relief. This review also highlights the ethical and safety considerations surrounding AI implementation, emphasizing data security and professional training. While challenges such as costs and regulatory hurdles exist, ongoing research and clinical trials demonstrate the practical utility of these technologies. In conclusion, AI and robotics have the potential to reshape regional anesthesia practice, ultimately improving patient care and procedural accuracy in pain management.

Nalbuphin as an Adjuvant to Levobupivacaine in Caudal Analgesia in Children

Abstract Background Caudal anethesia is the single most important pediatric regional anethetic technique and is increasingly performed in pediatric regional anesthesia practices. It is preferred in order to relieve intraoperative and postoperative pain in children of all age groups undergoing pelvi-abdominal or lower limbs surgeries using levobupivacaine 0.25%.Various adjuvant have been added to levobupivacaine to prolong postoperative caudal analgesia. Nalbuphine as many opioids can be added in caudal analgesia. This prospective randomised double blind study was done to compare the effects of plain levobupivacaine 0.25% versus Levobupivacaine 0.25% plus nalbuphine 0.1 mg/kg single-shot for postoperative pain relief in children undergoing hypospadius repair surgery. Materis and Methods At total of 64 pediatric patient 1 to 3 years old with American society of Anethesiologist (ASA) status | to |‖, undergoing hypospadius repair surgery were prospectively randomized into two groups, Group 1 received levobupivacaine 0.25% only 1 ml/kg plus 1 ml normal saline and group 2 received levobupivacaine 0.25% 1 ml/kg plus 0.1 mg/kg in 1 ml normal saline. The primary outcome of the study were time to first analgesia request, total consumption of rescue analgesia and the FLACC scale (face, legs, activity, cry and consonlability). The secondary outcome were heart rate (HR), mean arterial blood pressure (MAP), Oxygen saturation, occurrence of complications (respiratory depression, pruritis, xerostomia and postoperative nausea and vomiting). Results During surgery adequate intraoperative analgesia was defined by hemodynamic stability. An increase in the HR or MAP within 15 minutes greater than 15% compared to the baseline values obtained before skin incision recieved a rescue opioid in the form of fentanyl 5 mcg /kg and was excluded from the study. The difference between the two groups regarding time to first analgesia request was highly significant, group 1 (7.28±1.07), group 2 (11.59±2.54) (p &amp;lt; 0.01).The comparison between the two groups regarding the total consumption of rescue analgesia was also significant, group 1 (23.47±8.17), group 2 (19.23±7.31) (p &amp;lt; 0.05). There was statistically significant increase in FLACC in group 1 than group 2 at 30 min and up to 8 hours. There was no significant decrease in HR or MAP in group 2 more than group 1 except between 20 min and 8 hours. There was no statistically significant difference found between two studied groups regarding oxygen saturation regarding intraoperative and postoperative follow up. No patients in both groups had respiratory depression, xerostomia or pruritis.Few patients (3 _4) had postoperative nausea and vomiting with no statistically significant difference between the two groups. Conclusion The combination between nalbuphine and Levobupivacaine was valuable as regarding efficacy and safety profiles in pediatric analgesia. The intensity and duration of analgesia were remarkable compared to levobupivacaine alone. Fortunately, there were no side effects of systemic hazards recorded from systemic absorption of nalbuphine. To recommend considering nalbuphine as one of the valuable adjuvants to levobupivacaine in epidural analgesia according to its efficacy and safety profile.

Augmented Reality in Ultrasound-Guided Regional Anaesthesia: An Exploratory Study on Models With Potential Implications for Training.

Introduction Needle tip visualisation is a key skill required for the safe practice of ultrasound-guided regional anaesthesia (UGRA). This exploratory study assesses the utility of a novel augmented reality device, NeedleTrainer™, to differentiate between anaesthetists with varying levels of UGRA experience in a simulated environment. Methods Four groups of five participants were recruited (n = 20): novice, early career, experienced anaesthetists, and UGRA experts. Each participant performed three simulated UGRA blocks using NeedleTrainer™ on healthy volunteers (n = 60). The primary aim was to determine whether there was a difference in needle tip visibility, as calculated by the device, between groups of anaesthetists with differing levels of UGRA experience. Secondary aims included the assessment of simulated block conduct by an expert assessor and subjective participant self-assessment. Results The percentage of time the simulated needle tip was maintained in view was higher in the UGRA expert group (57.1%) versus the other three groups (novice 41.8%, early career 44.5%, and experienced anaesthetists 43.6%), but did not reach statistical significance (p = 0.05). An expert assessor was able to differentiate between participants of different UGRA experiencewhen assessing needle tip visibility (novice 3.3 out of 10, early career 5.1, experienced anaesthetists 5.9, UGRA expert group 8.7; p < 0.01) and final needle tip placement (novice 4.2 out of 10, early career 5.6, experienced anaesthetists 6.8, UGRA expert group 8.9; p < 0.01). Subjective self-assessment by participants did not differentiate UGRA experience when assessing needle tip visibility (p = 0.07) or final needle tip placement (p = 0.07). Discussion An expert assessor was able to differentiate between participants with different levels of UGRA experience in this simulated environment. Objective NeedleTrainer™ andsubjective participantassessmentsdid not reach statistical significance. The findings are novel as simulated needling using live human subjects has not been assessed before, and no previous studies have attempted to objectively quantify needle tip visibility during simulated UGRA techniques. Future research should include larger sample sizes to further assess the potential use of such technology.

SAFETY OF REGIONAL ANESTHESIA IN UKRAINE SURVEY: ARE HOSPITALS READY FOR THE LOCAL ANESTHETIC SYSTEMIC TOXICITY (LAST)?

Background. A survey was conducted among anesthesiologists in 38 Ukrainian hospitals to evaluate the current incidence and treatment quality of the local anesthetic systemic toxicity (LAST). With the growing preference for regional anesthetic techniques, implementation of measures for timely detection and treatment of LAST is becoming a priority for many surgical hospitals. This study aims to provide primary country-wide epidemiological data to guide further safety improvement in Ukraine.&#x0D; It should be noted, that the survey was performed before the beginning of the full-scale Russian invasion of Ukraine. The resulting surge in the incidence of limb injury has resulted in an unprecedented scale of application of regional anesthesia, including out-of-hospital cases with very limited monitoring, which will no doubt generate great amount of new data on the subject. We hope that our current analysis may be used as a reference point for the future research on this subject.&#x0D; Material and methods. A link to the survey was distributed via e-mail to the members of the Association of Anesthesiologists of Ukraine. Data submission was anonymous. Statistical analysis was performed using Microsoft Excel. Descriptive statistics are provided.&#x0D; Results. Responses were submitted by 186 anesthesiologists from 38 Ukrainian cities. Among them, 65.9% practice in public hospitals, 25.4% - in private hospitals, 8.7% - in university hospitals. Majority of respondents (60.3%) reported performing over 100 regional anesthetic procedures per year. Peripheral nerve blocks were routinely performed in the hospitals of 76.9% of respondents. 42.4% are using peripheral nerve blocks or more times per week, 24.4% perform this amount monthly, 21.7% - yearly, with 11.5% not utilizing peripheral nerve blocks at all.&#x0D; Ultrasound guidance was commonly used by 64.1% of anesthesiologists, 60.3% reported relying on landmark techniques often and 38.5% are routinely using a neuromuscular electrical stimulator.&#x0D; LAST cases were previously encountered by 37.2% of respondents. However, only 37% have reported having a LAST protocol in their hospital and 42.3% did not have a lipid emulsion available. Regarding patient education, in 62.8% of cases the patients were specifically warned about the possible complications of regional anesthesia prior to procedures, where it was performed. When the local anesthetic related adverse events did occur, they were recorded in the patient’s card in 27.2% of cases; the chief of anesthesiology department was informed in 36.9%, while in 35.9% the event was not reported in any way.&#x0D; Conclusions. The practice of regional anesthesia is becoming more widespread in Ukraine, but the minimal measures required to provide patient safety during such procedures are still not being employed in many hospitals.

Evaluation of Regional Anaesthesia Practice in Plastic Surgery: A Cross-sectional Study

Evaluation of Regional Anaesthesia Practice in Plastic Surgery: A Cross-sectional Study

Plan A blocks

With the increase in ultrasound use, regional anesthesia practices have gained popularity and many novel techniques are being described. However, the rapidly increasing number of new block techniques also led to confusion. Therefore, seven basic regional anesthesia techniques that are effective in most of the surgeries have been listed as 'Plan A Blocks.' The purpose of this review is to introduce the basic sono-anatomy and indications of Plan A blocks.

Orthopedic surgery case load and regional anesthesia practice trend at a tertiary care hospital during first wave of covid-19 pandemic

Objective: The aim of our study was to evaluate regional anesthesia practice trend in orthopedic surgeries during first three months of pandemic, April-June 2020 and compared with corresponding duration before it started. Tracheal intubation is considered one of the high-risk aerosols generating procedure and potential to transmit infection 6.6 times higher among those who are directly involved in airway management. The evidence for patient, surgical, institutional, and environmental benefits provided by regional anaesthesia is growing and are greatest when general anaesthesia can be avoided. Methods: This was a retrospective cohort and included all adult patients, who underwent orthopedic surgical procedures from 1st January 2020 to 30th June 2020, at Aga Khan University Hospital. Procedures done under general anesthesia, regional anesthesia, patients who had central neuraxial and peripheral nerve blocks performed for anesthesia and/or analgesia were included.

Orthopedic surgery case load and regional anesthesia practice trend at a tertiary care hospital during first wave of covid-19 pandemic

Objective: The aim of our study was to evaluate regional anesthesia practice trend in orthopedic surgeries during first three months of pandemic, April-June 2020 and compared with corresponding duration before it started. Tracheal intubation is considered one of the high-risk aerosols generating procedure and potential to transmit infection 6.6 times higher among those who are directly involved in airway management. The evidence for patient, surgical, institutional, and environmental benefits provided by regional anaesthesia is growing and are greatest when general anaesthesia can be avoided. Methods: This was a retrospective cohort and included all adult patients, who underwent orthopedic surgical procedures from 1st January 2020 to 30th June 2020, at Aga Khan University Hospital. Procedures done under general anesthesia, regional anesthesia, patients who had central neuraxial and peripheral nerve blocks performed for anesthesia and/or analgesia were included.

A French nationwide survey on the practice of regional anesthesia for breast cancer surgery

The aim of this study was to assess the impact of recent recommendations concerning regional anesthesia for breast cancer surgery, a nationwide practice survey was carried out. This cross-sectional electronic survey, conducted in 2021, collected answers from a panel of anesthetists currently working in French practicing centers. It addressed the sets of techniques they practiced for every type of surgical procedure and their perceptions of the difficulties and risks associated with these techniques. The practice of regional anesthesia was generally high (70%), involving all the current types of blocks. Surgeon-done infiltration was popular for lumpectomy only. For the other current procedures, the pectoralis nerve blocks were preferred to the paravertebral block, which was favored for mastectomies, when a lymph node harvesting was planned, or for immediate or delayed pedicle flap. Catheters were mostly used for mastectomies with pedicle flap. The erector spinae plane block was emergent. Whatever the type of block, regional anesthesia was preferentially started before surgery. Despite some deviations such as the adjunction of unlabeled molecules, the practice fitted well with the European recommendations, but training and within-center guidance lacked standardization. For each block, actual practice, perceived difficulty, and risk were inter-correlated, but paravertebral block - either practiced or not - was considered as more difficult and riskier to perform than any other. These encouraging results do not dispense with the need to improve anesthetic practices both in quantity and quality. Such improvement in the anatomic fit to the procedure and in the timing of blocks will also have to be considered.

Current Review of Analgesia and Regional Anesthesia Practices for Rib Fracture and Chest Wall Trauma

Current Review of Analgesia and Regional Anesthesia Practices for Rib Fracture and Chest Wall Trauma

Regional anaesthesia in patients on antithrombotic drugs: Joint ESAIC/ESRA guidelines.

Bleeding is a potential complication after neuraxial and peripheral nerve blocks. The risk is increased in patients on antiplatelet and anticoagulant drugs. This joint guideline from the European Society of Anaesthesiology and Intensive Care and the European Society of Regional Anaesthesia aims to provide an evidence-based set of recommendations and suggestions on how to reduce the risk of antithrombotic drug-induced haematoma formation related to the practice of regional anaesthesia and analgesia. A systematic literature search was performed, examining seven drug comparators and 10 types of clinical intervention with the outcome being peripheral and neuraxial haematoma. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the methodological quality of the included studies and for formulating recommendations. A Delphi process was used to prepare a clinical practice guideline. Clinical studies were limited in number and quality and the certainty of evidence was assessed to be GRADE C throughout. Forty clinical practice statements were formulated. Using the Delphi-process, strong consensus (>90% agreement) was achieved in 57.5% of recommendations and consensus (75 to 90% agreement) in 42.5%. Specific time intervals should be observed concerning the adminstration of antithrombotic drugs both prior to, and after, neuraxial procedures or those peripheral nerve blocks with higher bleeding risk (deep, noncompressible). These time intervals vary according to the type and dose of anticoagulant drugs, renal function and whether a traumatic puncture has occured. Drug measurements may be used to guide certain time intervals, whilst specific reversal for vitamin K antagonists and dabigatran may also influence these. Ultrasound guidance, drug combinations and bleeding risk scores do not modify the time intervals. In peripheral nerve blocks with low bleeding risk (superficial, compressible), these time intervals do not apply. In patients taking antiplatelet or anticoagulant medications, practitioners must consider the bleeding risk both before and after nerve blockade and during insertion or removal of a catheter. Healthcare teams managing such patients must be aware of the risk and be competent in detecting and managing any possible haematomas.

Regional anesthesia during COVID-19 pandemic: A minireview and practical recommendations

Background and aims: Coronavirus disease 2019 (COVID-19) has posed many challenges for healthcare workers around the world. This study aims to present the most appropriate and evidence-based scientific advice for safe regional anesthesia practice during the COVID-19 pandemic. Methods: To perform regional anesthesia during respiratory disease outbreaks, several databases were investigated, including PubMed, Google Scholar, Up-to-date, and ScienceDirect. Searches were in English during a timeframe spanning from February 15, 2019, until February 15, 2021, and the applied keywords were "COVID-19 anesthesia", "surgery", and "operating room" Results: We have focused on definite areas such as workforce and resource planning, modification of clinical setting, preparation of equipment, supplies, and medications, selection of proper personal protective equipment (PPE), cardiorespiratory monitoring of the patient, and sedation and oxygen therapy. Other fields were assessing safe regional anesthesia techniques and monitoring during anesthesia, post-anesthesia care, and follow-ups. In these recommendations, keeping the patients safe while protecting healthcare providers from potential exposure to infection is of particular interest. Conclusion: The safety of healthcare workers and patients during the anesthesia management of suspected and positive COVID-19 cases is of utmost importance. Although there is limited evidence regarding performing regional anesthesia, these presented suggestions summarize the best accessible data and explain some doubts in this respect.