Outcome of major abdominal surgeries in COVID-19 positive patients with awake anaesthesia: surgeons’ perspective


  • Kailash K. Thakuria Department of General Surgery, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India
  • Naveen Kumar M. Department of General Surgery, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India
  • Monmohan Boro Department of General Surgery, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India




Awake surgery, Laparotomy, Locoregional anaesthesia, COVID-19


In view of the COVID-19 pandemic, the use of locoregional anaesthesia has gained popularity as the greatest number of the major abdominal surgical cases which were usually done under general anaesthesia (GA) is now shifted towards awake anaesthesia due to fear of aerosol generation. In a COVID era, with evolving risk of aerosol generation in surgery under GA and the urge for reserving ICU beds for needy patients, this study was undertaken to assess the adequacy of surgery and other benefits with awake anaesthesia. A retrospective observational study for 8 COVID-19 positive patients, undergoing emergency major abdominal surgeries with locoregional anaesthesia in pre-operatively diagnosed COVID positive from May 2020 to May 2021 was conducted. Low to medium risk patients (ASA 1-2) were considered following assessment by anaesthesiologist. We retrospectively analysed data including perioperative events, post-op follow up. The mean operative time was 103 minutes (minimum 50 minutes; maximum 170 minutes). In one case, conversion to general anaesthesia was necessary. Post-operative pain was always well controlled. None of them required postoperative intensive care support. No perioperative major complications (Clavien Dindo ≥3) occurred. Early readmission after surgery never occurred. In our experience in the COVID-19 era, RA may help to limit the intubation-related risk of contagions inside theatres and could be feasible, safe, and painless alternative to GA in selected cases and this approach could become part of an ICU-preserving strategy.


WHO. Fact sheet: Coronavirus COVID-19 pandemic. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed on 21 October 2021.

Yao W, Wang T, Jiang B, Gao F, Wang L, Zheng H, et al. Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations. Br J Anaesth. 2020;125(1):28-37.

Coccolini F, Perrone G, Chiarugi M, DiMarzo F, Ansaloni L, Scandroglio I, et al. Surgery in COVID-19 patients: operational directives. World J Emerg Surg. 2020;15(1):25.

Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon. 2005;51(2-3):70-8.

Dindo D, Demartines N, Clavien P. Classification surgical complications. Ann Surg. 2004;240(2):205-13.

Veziant J, Bourdel N, Slim K. Viral Contamination risks caregivers during a laparoscopy during the pandemic COVID-19. J Chir Visc. 2020;157(3):60-3.

Yu GY, Lou Z, Zhang W. Several suggestions of operation for colorectal cancer under the outbreak of corona virus disease 2019 in China. Zhonghua Wei Chang Wai Ke Za Zhi. 2020;23(3):208-11.

Zheng MH, Boni L, Fingerhut A. Minimally invasive surgery and the novel Coronavirus outbreak: Lessons learned in China and Italy. Ann Surg. 2020;272(1):5-6.

Soliman M. Controversies in CO2 insufflation and COVID-19. Tech Coloproctol. 2020;24(7):667-70.

Macfarlane AJR, Harrop-Griffiths W, Pawa A. Regional anaesthesia and COVID19: first choice at last? Br J Anaesthes. 2020;125(3):243.

Surbeck W, Hildebrandt G, Duffau H. The evolution of brain surgery on awake patients. Acta Neurochir (Wien). 2015;157(1):77-84.

Cotugno M, Dallaglio M, Cantadori L, Villani F, Martens D, Cantoni F, et al. Right open nephrectomy under combined spinal and peridural operative anesthesia and analgesia (CSE): a new anesthetic approach in abdominal surgery. Arch Ital Urol Androl. 2020;91(4):267-8.

Castellani D, Starnari R, Faloia L, Stronati M, Venezia A, Gasparri L, et al. Radical cystectomy in frail octogenariansin thoracic continuous spinal anesthesia and analgesia: a pilot study. Ther Adv Urol. 2018;10:343-9.

Romanzi A, Galletti M, Macchi L, Putortì A, Rossi F, Scolaro R, et al. Awake laparotomy: is locoregional anesthesia a functional option for major abdominal surgeries in the COVID-19 era? Eur Rev Med Pharmacol Sci. 2020;24(9):5162-6.

Piccioni F, Mariani L, Negri M, Casiraghi C, Belli F, Leo E, et al. Epidural analgesia does not influence anastomotic leakage incidence after open colorectal surgery for cancer: a retrospective study on 1,474 patients: Epidural Analgesia and Anastomotic Leak. J Surg Oncol. 2015;112(2):225-30.

Etta OE, Umeh K, Akpan SG. Thoracic epidural anaesthesia for major abdominal surgeries: experience in private hospital setting in Uyo, South-South Nigeria. South Afr J Anaesthes Analg. 2016;22(3):86-8.

Consani G, Amorese G, Boggi U, Comite C, Avagliano E. Laparotomic sub-total gastrectomy under awake thoracic epidural anaesthesia: a successful experience. Update Surg. 2013;65(3):255-6.

Kyeong KM, Shin J, Choi JH, Kang HY. Low dose combined spinal-epidural anesthesia for a patient with a giant hiatal hernia who underwent urological surgery. J Int Med Res. 2018;46(10):4354-9.

Imbelloni LE. Spinal anesthesia for laparoscopic cholecystectomy: thoracic vs. lumbar technique. Saudi J Anaesth. 2014;8(4):477-83.

Vincenzi P, Starnari R, Faloia L, Grifoni R, Bucchianeri R, Chiodi L, et al. Continuous thoracic spinal anesthesia with local anesthetic plus midazolam and ketamine is superior to local anesthetic plus fentanyl in major abdominal surgery. Surg Open Sci. 2020;2(4):5-11.






Case Series