Table 1.

Recommendations for regional anaesthesia for the patient with confirmed or suspected COVID-19.¹^,²^,¹¹^,³⁰ FFP3, filtering face piece 3; PPE, personal protective equipment; RA, regional anaesthesia.

Phase of care	Issue	lePotential solution
Preoperative	Team brief/plan	• Discuss surgical plan, duration, aerosol generation, appropriate PPE and potential complications with surgical team. Ideally before seeing patient.
	Preoperative assessment	• Access electronic health record (EHR). • Virtual pre-assessment via telephone/video call. • If virtual pre-assessment/EHR not possible – consider assessment of patient in theatre (preserve PPE). • Check bloods – particular attention to platelet count (thrombocytopaenia) and clotting.
	Pre-existing neurological deficit	• Examine for pre-existing neurological deficit and document if present
	Consent	• Discuss material risks and benefits of regional anaesthesia. • Provide alternative choices. • Frank discussion on reasons for general anaesthesia avoidance. • Document discussion.
	Equipment	• Don PPE meticulously outside the theatre. • Select and prepare appropriate monitoring, equipment. • Only take essential items into theatre. • Have a runner available for additional equipment and drugs. • Plastic cover/drape on reusable equipment such as ultrasound and nerve stimulator – consider role of hand held devices vs cart-based systems. • Plan sedation and airway rescue strategy.
	Transfer to operating theatre	• Patient should be transferred to theatre wearing a surgical facemask. Oxygen mask if required can be placed on top of surgical facemask.

Intraoperative	Technique	• Choose most appropriate technique to cover osteotomes, myotomes, dermatomes and tourniquet if required. Account for visceral supply where appropriate in abdominal procedures. • Choose technique with least complications to be sited by most appropriate practitioner (e.g. phrenic nerve sparing upper limb techniques with lowest pneumothorax risk – axillary or infraclavicular brachial plexus blocks, or technique most familiar with). • Use ultrasound to site peripheral nerve blocks (PNBs) ideally. • No dose adjustment of local anaesthetics required. • Consider adjuvants o To prolong block in PNBs o Ensure suitable postoperative monitoring in place for intrathecal opioids • Consider a mobile ‘block team’ if available.
	Siting of block	• Site block in theatre with essential staff present. • Ensure patient wearing surgical mask. • Oxygen mask over surgical facemask or nasal cannulae under surgical mask. • PPE – Droplet and Contact PPE will suffice for most instances unless concern of conversion to GA or very close contact to patient necessary in which case FFP3 mask may be considered. • Ensure Ultrasound probe within sheath before scanning.
	Post-block insertion	• Allow sufficient time for block to work. • Check block meticulously. • If in doubt, site supplementary block if appropriate. • Continuous monitoring and use of oxygen therapy and sedation if required – avoid high flow oxygen and deep sedation. • Have plan for surgical infiltration/rescue if required. • Maintain distance of 2 m from patient if possible. • Monitor for local anaesthetic systemic toxicity (LAST).

Postoperative	Recovery	• Ideally recover within theatre and transfer patient to final destination wearing surgical face mask as before. • Ensure postoperative instructions are documented including monitoring for adverse effects. • Prescribe regular postoperative analgesia to commence before block regression and appropriate breakthrough analgesia.
	Equipment decontamination	• Dispose of and decontaminate equipment carefully including ultrasound using appropriate materials (quaternary ammonium chloride disinfectant wipes). • Doff PPE carefully.
	Documentation	• Clearly document procedure and outcome – electronically ideally.
	Follow-up	• Remote follow up via telephone or electronic health record. • Provide contact details. • Consider creating an RA database.