The COVID-19 pandemic and the regional orthopedic anesthesia guidelines

BACKGROUND: The infection of humans with virus SARS-Cov-2 was first reported in December 2019, in Wuhan, China and in 11th March 2020, COVID-19 was declared a pandemic by the World Health Organization. Since transmission was mainly through inhalation of droplets, general anesthesia was considered a high-risk transmission procedure. In this context, to choose regional anesthesia whenever possible, was recommended. Our main aim was to analyze if COVID-19 lead to an increased use of regional anesthesia in orthopedic surgeries. METHODS: Based on the orthopedic anesthetic activity of Hospital de Cascais (Portugal), two six months periods were compared: one following the resume of surgical activity after the first pandemic wave (“after COVID period”) and the homologous period of the previous year (“before COVID period”). Both periods were assessed for homogeneity for: age, sex, ASA status, contraindications for regional anesthesia, type of surgery, duration, priority and outpatient/inpatient care. Chi-square or Fisher tests were applied, as well as a binary logistic regression. RESULTS: Periods were significantly different for care (p = 0,0028), with more outpatient surgery in the after COVID period (43% versus 37,2%). No bivariate association was identified between periods and anesthesia. However, the binary logistic regression showed higher odds of being submitted to regional anesthesia in the after COVID period (p = 0,002 OR = 1,507 CI95%[1,156-1,964]). CONCLUSIONS: Possible explanations for absent bivariate association between period and anesthesia, are that all patients were tested for COVID-19, and the higher number of outpatient surgery (for which general anesthesia is preferred) in the after COVID period. When all predictors were controlled with the binary logistic regression, the guidelines seemed to have been followed. However, the lower limit of CI95% is near 1. This may indicate that in the future, further efforts to implement regional anesthesia guidelines, may be needed. KEY MESSAGES: • COVID-19 Guidelines for regional anesthesia were followed but additional efforts are needed, as new pandemics are expected. • As a preventive measure for future pandemics, training programs of regional anesthesia should be mandatory.