Hospitals and surgery centers across the US, indeed across the globe, are facing increasing elective surgery backlogs in the wake of the Covid-19 pandemic. Combined with growing workforce shortages in healthcare and continuing concerns over future waves of covid infections, healthcare providers are having to develop strategies to manage the growing pressures and challenges they are facing to deliver elective services.
It has been estimated that it could take up to 2 years to work through surgical backlogs [1]. Strategies could include increasing surgical throughput by extending the number of daily operation hours, including at weekends, and taking proactive steps to minimize cancellations. Optimizing the length of stay for patients will also be a key approach.
Regional anesthesia offers advantages over general anesthesia in terms of potential to reduce length of stay and facilitate delivery of treatment in ambulatory surgical centers. During the pandemic guidance was issued that regional anesthesia (RA) should be considered in preference to general anesthesia to minimise risk of transmission [2]. More recent recommendations around timing of elective surgery post Covid-19 infection are for elective surgery to be avoided within 7 weeks of infection, and for patients with recent or peri-operative infection, local or regional anesthesia techniques should be considered [3]. Given this, RA could have an important role to play in ensuring electives go ahead wherever possible, supporting efficient use of surgical capacity.
Where resource challenges over availability of nursing staff could pose another challenge, a widely available technology to support safer injection during pre-operative peripheral nerve blocks can offer a solution, as well as promoting patient safety. The SAFIRA® system transforms the traditional two-operator regional anesthesia process into a single-operator procedure by giving the anesthesiologist full control of the injection without the need for an assistant. Using a foot pedal or a palm operator they can control both aspiration and infusion of local anesthetic while still being able to use ultrasound to guide needle placement. There is no requirement to find an assistant before a regional block can be completed, and it frees up any nursing staff for other essential tasks in the OR or block room.
The SAFIRA® system also has a built-in safety mechanism which limits injection pressure to a specified threshold by automatically stopping injection, prompting the clinician to make the necessary checks before resetting to continue injection. This helps to reduce the risk of nerve injury from injection at high pressure, promoting patient safety and better patient outcomes. In a system already under pressure, reducing the potential requirement for follow on management of nerve injury is another way to alleviate resource pressure and save costs.
As healthcare providers continue to manage the effects of Covid-19 on healthcare services and tackle the elective backlog, safe and effective regional anesthesia could have a key role to play.
References
- “Cutting through the Covid-19 surgical backlog”, Gretchen Berlin, David Bueno, Kyle Gibler, and John Schulz – article published October 2, 2020 https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/cutting-through-the-covid-19-surgical-backlog?cid=eml-web
- Practice Recommendations on Neuraxial Anesthesia and Peripheral Blocks during the COVID-19 Pandemic, Uppal V, Sondekoppam RV, Lobo CA, Kolli S, Kalagara HKP. www.asra.com/covid-19/raguidance
- “Timing of elective surgery and risk assessment after SARS-CoV-2 infection: an update”, El-Boghdadly K., Cook T., Goodacre T., et al. Published 22 February 2022; https://doi.org/10.1111/anae.15699