Journal of Anaesthesia & Critical Care Case Reports

Vol 6 | Issue 3 | September-December 2020 | Page 08-10 | Maria Alexandra Tsoutsou, Shiv Kumar Singh

Author: Maria Alexandra Tsoutsou [1], Shiv Kumar Singh [1]

[1] Department of Anaesthesia, Royal Liverpool University Hospital, Prescot St, Liverpool L7 8XP, United Kingdom.

Address of Correspondence
Dr. Maria Alexandra Tsoutsou,
Clinical Fellow in Perioperative medicine and Anaesthesia, Royal Liverpool University Hospital, Prescot St, Liverpool L7 8XP, United Kingdom.
E-mail: maria.tsoutsou@nhs.net

Covid-19 and Regional Anaesthesia: Use of Ultrasound guided Popliteal Sciatic Nerve Blocks for Emergency Forefoot Amputation in a High Risk Deaf and Mute Covid-19 Contact Patient

Abstract

Introduction: COVID-19 has brought in the foreground the benefits of regional anaesthetic techniques as the preferred method of anaesthesia when possible. While there are many case reports of peripheral nerve blocks successfully used during the pandemic, to our knowledge this is the first case report of the use of regional anaesthesia for peripheral limb surgery for high risk deaf and mute COVID-19 contact patient and challenges one encounters in patients with this disability.
Case Presentation: A 65-year-old man presented as an emergency with critical left lower limb ischaemia. Initially, a left common femoral and profunda femoris endarterectomy were performed under general anaesthesia that led to unplanned admission to the HDU for vasopressor support due to persistent hypotension. Following the initial procedure, his symptoms failed to improve, with ongoing forefoot pain and signs of infection. The decision was made to proceed to a forefoot debridement that was successfully performed under peripheral nerve block and patient discharged back to the ward without any peri-op complications.
Conclusion: In this case report we describe the use of regional techniques to facilitate the emergency procedure with a view to minimising risk to the patient with a previous history of requiring prolonged vasopressor support and unplanned HDU admission after general anaesthesia. His status as a COVID-19 bay contact and as a high risk deaf and mute patient where communication is an issue make this an interesting case.
Keywords: COVID-19; Regional anaesthesia; Forefoot amputation; Contact positive; Deaf and mute.

References

1. Uppal V, Sondekoppam rV, Lobo CA, et al. Practice recommendations on neuraxial anesthesia and peripheral nerve blocks during the COVID-19 Pandemic- a joint statement by the American Society of regional anesthesia and pain medicine (ASrA) and european Society of regional anesthesia and pain therapy (eSrA), March 31, 2020. Available: https:// www.asra.com/content/documents/ra-covid19_final. pdf
2. Guidance on potential changes to anaesthetic drug usage and administration during pandemic emergency pressures ICM Anaesthesia COVID-19. [cited 2020 Nov 26]. Available from: https://icmanaesthesiacovid-19.org/drug-demand-supply-anaesthetic-drug-usage-andadministration
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5. Mistry T, Singh SK. COVID-19 Pandemic Regional Anesthesia Should Be The New Norm, Reg Anesth Pain Med doi:10.1136/rapm-2020-101642

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