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Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 70-71

Spread the local, not the virus!

1 Department of Medicine, Unit of Anaesthesia, Intensive Care and Pain Management, Universita, Campus Bio-Medico di Roma, via Alvaro del Portillo 21, 00128 Rome, Italy
2 Department of Anaesthesia, Intensive Care and Pain Management, Humanitas Mater Domini, Via, Gerenzano 2, 21053 Castellanza (VA), Italy

Correspondence Address:
Dr. Alessandro Strumia
Via Alvaro del Portillo 200-00128, Rome
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sja.SJA_596_20

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Date of Submission04-Jun-2020
Date of Acceptance07-Jun-2020
Date of Web Publication5-Jan-2021

How to cite this article:
Costa F, Pascarella G, Del Buono R, Strumia A, Agrò FE. Spread the local, not the virus!. Saudi J Anaesth 2021;15:70-1

How to cite this URL:
Costa F, Pascarella G, Del Buono R, Strumia A, Agrò FE. Spread the local, not the virus!. Saudi J Anaesth [serial online] 2021 [cited 2022 Aug 16];15:70-1. Available from:

To the Editor,

There is growing interest in the importance of lung ultrasound (LUS) in the management of the coronavirus disease 2019 (COVID-19) for both diagnosis and follow-up. Lots of effort had to go into health care workers (HCWs) protection; LUS could be crucial, decreasing the number of HCWs and medical devices interactions with potential infectious patients.[1]

World Health Organization recommends social distancing and rationale use of personal protection equipment (PPE). Special attention was given to aerosol-generating procedures (AGPs) such as airways management for surgical procedures.[2],[3]

Considering the possibility of facing nonsymptomatic infections, precautions had to be taken in the management of all the patients. A lack of the appropriate protection may lead to HCWs infection: an infected asymptomatic worker may potentially increase the virus spread while infected symptomatic personnel represents a decrease in the hospital workforce.[4] Providing safe health care for the non-COVID population should be mandatory for both patients and medical staff.

In our institution (University Hospital Campus Bio-Medico, Rome, Italy), we prevent this occurrence through the adoption of the above-mentioned safety measures. Elective activities have been reduced, except for critical and oncological patients. Only patients with no suspected COVID-19 symptoms are admitted, and they are all provided with a surgical face mask; the HCWs are equipped with filtering facepiece class 2 (FFP2) respirators by default while workers involved in AGPs are equipped with FFP3 respirators and eye protection PPE.

The European and American Societies of Regional Anesthesia recommends performing regional anesthesia for managing COVID-19 positive patients undergoing surgery to limit AGPs.[5]

In our hospital, wherever indicated and after informed consent obtained from the patient, we prefer to perform all surgeries under regional anesthesia as the sole anesthetic technique, thus airways management could be avoided, aiming to improve health care safety for both patients and providers [Figure 1].
Figure 1: Patient wearing personal face mask during nipple sparing, modified radical mastectomy with breast tissue expander implantation for reconstruction

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If necessary, mild sedation could be administered and supplemental oxygen could be delivered through an oxygen mask (not through nasal cannulas) over the patient's PPE.

As ultrasound is helping HCWs in the COVID-19 daily practice,[1] it is also a key tool for the management of surgical patients, guiding the perineural spread of local anesthetic rather than a virus spread through AGPs.

Throughout the epidemic, we rediscovered the important role of regional anesthesia, as a protective factor against COVID-19 diffusion. It is a fact that aerosol is generated whenever airway management occurs: so, why not remove these procedures at all?

We are facing a choice about the agent to be spread: the local anesthetic or the virus. Whenever possible, choose the first one.

  Declaration of patient consent Top

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Buonsenso D, Pata D, Chiaretti A. COVID-19 outbreak: less stethoscope, more ultrasound. Lancet Respir Med 2020;8:e27.  Back to cited text no. 1
Pascarella G, Strumia A, Piliego C, Bruno F, Del Buono R, Costa F, et al. COVID-19 diagnosis and management: a comprehensive review. J Inter Med 2020. doi: 10.1111/joim. 13091.  Back to cited text no. 2
Tran K, Cimon K, Severn M, Pessoa-?Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: A systematic review. PLoS One 2012;7:e35797.  Back to cited text no. 3
Wölfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Müller MA, et al. Virological assessment of hospitalized patients with COVID-2019. Nature 2020; 581:465-9.  Back to cited text no. 4
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). 2020.  Back to cited text no. 5


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