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Scalp Nerve Block: An Extended Use of Aerosol Box in COVID 19 Pandemic.

To JNA Readers: Aerosol generation while performing airway intervention during general anesthesia exposes the anesthesiologist to increased risk of COVID-19 transmission. Hence, the American Society of Regional Anaesthesia and PainMedicine and the European Society of Regional Anaesthesia and Pain Therapy recommend regional anesthesia over general anesthesia whenever feasible.1 Besides awake craniotomy, deep brain stimulation, stereotactic radiosurgery and cranioplasty surgery, burr hole drainage of chronic subdural hemorrhage is another indication for scalp nerve block.2 While performing scalp nerve blocks (supraorbital, supratrochlear, auriculotemporal, zygomaticotemporal, greater occipital, and lesser occipital nerves) neuroanesthesiologists are more susceptible to exposure to COVID-19 infection owing to their close proximity to the patient’s face. In addition, spontaneous sneezing and coughing can occur or be triggered during performance of the scalp block because of trigeminal nerve stimulation or intravenous sedation.3,4 A patient may cause airborne spread of aerosol even at a distance of > 3m and it is very likely for the cough jet from a patient with COVID-19 to contain pathogens, and hence risk airborne spread.5 The aerosol box with high-flow negative suction and a high-efficiency particulate air (HEPA) filter has been introduced for additional protection of health care workers from high aerosol generating airway procedures.6 We describe a novel use of an aerosol box, which was locally designed and manufactured by the Anesthesia and Critical Care team at our institution, during scalp nerve block (Fig. 1); the aerosol box is made of transparent acrylic and measures 50 cm×50 cm×40 cm. We recommend using an aerosol box with other personal protective measures during scalp nerve block or any head and neck regional block procedure to minimize aerosol spread and infection transmission during the COVID-19 pandemic.