Coronavirus (COVID-19): regional anaesthesia to reduce drug use in anaesthesia and avoid aerosol generation

This page provides the available evidence from Cochrane Reviews produced by Cochrane Anaesthesia and aims to better inform these debates and support decision-making when planning regional anaesthesia.

◆Regional anaesthesia compared with conventional analgesic techniques

-Neuraxial blockade for the prevention of postoperative mortality and major morbidity: an overview of Cochrane systematic reviews
-Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children
-Transient neurological symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics in adult surgical patients: a network meta‐analysis

◆How best to perform regional anaesthesia and which local anaesthetics and adjuncts to use

-Air versus saline in the loss of resistance technique for identification of the epidural space
-Ultrasound guidance for upper and lower limb blocks
-Hyperbaric versus isobaric bupivacaine for spinal anaesthesia for caesarean section
-Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults undergoing surgery of the lower arm
-Dexamethasone as an adjuvant to peripheral nerve block
-Adrenaline with lidocaine for digital nerve blocks
-Liposomal bupivacaine peripheral nerve block for the management of postoperative pain

◆Orthopaedic surgery

-Regional analgesia for improvement of long‐term functional outcome after elective large joint replacement
-Femoral nerve blocks for acute postoperative pain after knee replacement surgery
-Nerve blocks or no nerve blocks for pain control after elective hip replacement (arthroplasty) surgery in adults
-Anaesthesia for hip fracture surgery in adults
-Peripheral nerve blocks for hip fractures in adults
-Adductor canal blocks for postoperative pain treatment in adults undergoing knee surgery
-Continuous interscalene brachial plexus block versus parenteral analgesia for postoperative pain relief after major shoulder surgery

◆General surgery and vascular surgery

-Epidural pain relief versus systemic opioid‐based pain relief for abdominal aortic surgery
-Epidural local anaesthetics versus opioid‐based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery
-Epidural analgesia versus patient‐controlled intravenous analgesia for pain following intra‐abdominal surgery in adults

◆Cardiothoracic surgery

-Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass
-Paravertebral block versus thoracic epidural for patients undergoing thoracotomy

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