The role of continuous spinal anesthesia on COVID-19 pandemic - Case Report

ABSTRACT

Continuous Spinal Anesthesia (CSA) can be an option for high-risk comorbid patients undergoing major abdominal surgery and may be advantageous compared to general anesthesia in selected patients. CSA allows a better postoperative analgesia, less effect on respiratory physiology and a faster return to oral intake. It ensures a faster recovery, particularly important in COVID-19 pandemic, to reduce the length of hospital stay and the admissions in postoperative intensive care units. We report a fifty-year-old man, ASA III, proposed to an urgent segmental enterotomy due to an acute bowel obstruction. Patient's personal history included an acute exacerbation of chronic obstructive pulmonary disease caused by pneumonia diagnosed two days before (Figure1). For this reason and lack of available intensive care unit beds due to COVID-19 pandemic, we decided to perform a CSA in L1-L2 space. A bolus of hyperbaric bupivacaine 5mg and sufentanil 2mcg was administered and the next bolus were titrated to patient complaints. The procedure lasted 2h15min, and the patient remained hemodynamically stable and with no complaints of pain, nausea or vomiting. The catheter was removed at the end of the procedure. COVID-19 has burdened health care systems reducing the critical care units available for non-COVID- 19 patients. This limitation and also the risk of contamination, induced an adaptation of anesthesia guidelines advised to consider regional anesthesia whenever possible. Despite the advantages, CSA has also disadvantages and risks that need to be considered, such as hemodynamic instability and respiratory distress if a high block is achieved. This technique allows to perform surgical interventions in patients who would otherwise be classified as non-eligible to surgery or who would be postponed due to lack of available beds in postoperative intensive care units. Since it avoids airway approach, it also allows healthcare protection during COVID-19 pandemic.