The practice of regional anesthesia during the COVID-19 pandemic: an international survey of members of three regional anesthesia societies.

PURPOSE: To determine the preferences and attitudes of members of regional anesthesia societies during the COVID-19 pandemic. METHODS: We distributed an electronic survey to members of the American Society of Regional Anesthesia and Pain Medicine, Regional Anaesthesia-UK, and the European Society of Regional Anaesthesia & Pain Therapy. A questionnaire consisting of 19 questions was developed by a panel of experienced regional anesthesiologists and distributed by email to the participants. The survey covered the following domains: participant information, practice settings, preference for the type of anesthetic technique, the use of personal protective equipment, and oxygen therapy. RESULTS: The survey was completed by 729 participants from 73 different countries, with a response rate of 20.1% (729/3,630) for the number of emails opened and 8.5% (729/8,572) for the number of emails sent. Most respondents (87.7%) identified as anesthesia staff (faculty or consultant) and practiced obstetric and non-obstetric anesthesia (55.3%). The practice of regional anesthesia either expanded or remained the same, with only 2% of respondents decreasing their use compared with the pre-pandemic period. The top reasons for an increase in the use of regional anesthesia was to reduce the need for an aerosol-generating medical procedure and to reduce the risk of possible complications to patients. The most common reason for decreased use of regional anesthesia was the risk of urgent conversion to general anesthesia. Approximately 70% of the responders used airborne precautions when providing care to a patient under regional anesthesia. The most common oxygen delivery method was nasal prongs (cannula) with a surgical mask layered over it (61%). CONCLUSIONS: Given the perceived benefits of regional over general anesthesia, approximately half of the members of three regional anesthesia societies seem to have expanded their use of regional anesthesia techniques during the initial surge of the COVID-19 pandemic.

RéSUMé: OBJECTIF: Déterminer les préférences et les attitudes des membres des sociétés d'anesthésie régionale pendant la pandémie de COVID-19. MéTHODE: Nous avons distribué un sondage électronique aux membres de l'American Society of Regional Anesthesia and Pain Medicine, de Regional Anesthesia-UK et de l'European Society of Regional Anaesthesia & Pain Therapy. Un questionnaire composé de 19 questions a été élaboré par un panel d'anesthésiologistes régionaux d'expérience et distribué par courriel aux participants. Le sondage couvrait les domaines suivants : les renseignements sur les participants, les contextes de pratique, leur préférence quant au type de technique d'anesthésie, l'utilisation d'équipement de protection individuelle et l'oxygénothérapie RéSULTATS: Le sondage a été complété par 729 participants provenant de 73 pays différents, avec un taux de réponse de 20,1 % (729/3630) pour le nombre de courriels ouverts et de 8,5 % (729/8572) pour le nombre de courriels envoyés. La plupart des répondants (87,7 %) se sont identifiés comme anesthésiologistes (académique ou consultant) et pratiquaient l'anesthésie obstétricale et non obstétricale (55,3 %). Leur pratique de l'anesthésie régionale s'est étendue ou est demeurée inchangée, et seulement 2 % des répondants ont indiqué avoir diminué leur utilisation de cette pratique par rapport à la période pré-pandémique. Les principales raisons d'une augmentation de l'utilisation de l'anesthésie régionale étaient de réduire la nécessité d'une intervention médicale générant des aérosols et de réduire le risque de complications potentielles pour les patients. La raison la plus courante de diminution du recours à l'anesthésie régionale était le risque de conversion urgente à une anesthésie générale. Environ 70 % des intervenants ont utilisé des précautions en matière de propagation des aérosols lorsqu'ils procuraient des soins à un patient sous anesthésie régionale. La méthode d'administration d'oxygène la plus fréquemment utilisée était les canules nasales avec un masque chirurgical superposé (61 %). CONCLUSION: Compte tenu des avantages perçus de l'anesthésie régionale par rapport à l'anesthésie générale, environ la moitié des membres de trois sociétés d'anesthésie régionale semblent avoir élargi leur utilisation des techniques d'anesthésie régionale pendant la vague initiale de la pandémie de COVID-19.

A Cohort Study of Emergency Surgery Caseload and Regional Anesthesia Provision at a Tertiary UK Hospital During the Initial COVID-19 Pandemic.

Study objective  Analysis of emergency cases performed during initial coronavirus disease 2019 (COVID-19) pandemic and the proportion completed under regional anesthesia (RA). Design Cohort study comparing surgical caseload during initial seven-week COVID-19 pandemic in 2020. Comparison was made with pre-COVID-19 caseload over the corresponding seven-week timeframe in 2019. Setting The setting of the study was emergency surgery theaters at Guy's and St Thomas' NHS Foundation Trust, London, UK. Patients All patients requiring emergency surgery over the defined study period were reviewed with the exception of obstetric and pediatric populations. Interventions Surgical caseload for 2020 and 2019 cohorts established using the Galaxy IT system used to log all operations. All relevant anesthetic charts for the 2020 cohort were subsequently reviewed to ascertain perioperative use of RA. Measurements The type of block, mode of approach, experience of the operator, personal protective equipment (PPE) worn, block complications, type of sedation and complications were entered into database. Main results A total of 338 emergency surgical cases were performed during the COVID-19 pandemic in 2020, compared to 603 cases over the corresponding period in 2019. This showed a 44% decrease in emergency surgical workload. There was a marked disparity in reduction of surgical caseload by surgical subspecialty. Trauma (137 vs 66 cases), a 52% decrease, and general surgery (193 vs 64 cases), a 66% decrease, were the most pronounced, and explanations for this are explored. RA was performed in 34% (26% as primary technique) of cases during the COVID-19 pandemic. The use of RA as the primary anesthesia technique was noticeably higher than previous UK data (11%), and was prominent in specialties such as general surgery, gynecology and urology, not traditionally completed under RA. Conclusions Surgical RA (and general anesthesia avoidance) has a significant role in the future to ensure high-quality perioperative care for patients whilst minimizing exposure to staff and utilization of scarce resources (PPE).