Patient Discomfort Following Pectoral Defibrillator Implantation Using Conscious Sedation

Bollmann, Andreas; Marx, Alexandra; Sathavorn, Charn; Mera, Fernando; Delurgio, David B.; Walter, Paul F.; Langberg, Jonathan J.

doi:10.1111/j.1540-8159.1999.tb00335.x

Cited by 8 publications

(5 citation statements)

References 6 publications

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“…Postoperative pain after cardiac device implantation has been reported to be 34 6 20 mm immediately after the procedure, decreasing to 19 6 18 mm at 1 month. 24 Postoperative pain from UAS shows a similar postoperative profile with pain a VAS of 31.6 6 19.0 mm, which decreases to 17.1 6 17.5 mm at 1 week. Compared to historical data for traditional airway reconstructive surgery for OSA, such as uvulopalatopharyngoplasty (UPPP), postoperative pain was substantially lower in severity and duration for the UAS implant procedure (Fig.…”

Section: Discussionmentioning

confidence: 64%

“…Wound pain typically resolves on its own but oral analgesic medications can be considered postoperatively. Postoperative pain after cardiac device implantation has been reported to be 34 ± 20 mm immediately after the procedure, decreasing to 19 ± 18 mm at 1 month . Postoperative pain from UAS shows a similar postoperative profile with pain a VAS of 31.6 ± 19.0 mm, which decreases to 17.1 ± 17.5 mm at 1 week.…”

Section: Discussionmentioning

confidence: 91%

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Upper airway stimulation for obstructive sleep apnea: The surgical learning curve

et al. 2015

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 91%

Upper airway stimulation for obstructive sleep apnea: The surgical learning curve

et al. 2015

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“…showed that 86% of patients who underwent subpectoral ICD implantation under conscious sedation had a mean VAS score of 34 ± 20 at 24 h after the procedure. [ 11 ] Chronic shoulder pain and disability were described in 54% of patients for more than 3 years after ICD implantation. [ 12 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of pectoral Nerve (PECS1) block with combined PECS1 and transversus thoracis muscle (TTM) block in patients undergoing cardiac implantable electronic device insertion – A pilot study

Nagaraja¹,

Arasu²,

Ragavendran³

et al. 2020

Ann Card Anaesth

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Background: Pectoral nerve (PECS1) block has been used for patients undergoing cardiac implantable electronic device (CIED) insertions, however, PECS1 block alone may lead to inadequate analgesia during tunneling and pocket creation because of the highly innervated chest wall. Transversus thoracis muscle plane (TTM) block targeting the anterior branches of T2-T6 intercostal nerves can be effectively used in combination with PECS1 for patients undergoing CIED insertion. The present study hypothesized that combined PECS1 and TTM blocks would provide effective analgesia for patients undergoing CIED insertion compared to PECS1 block alone. Materials and Methods: Thirty adult patients between the age group of 18–85 years undergoing CIED insertion were enrolled in the study. A prospective, randomized, comparative, pilot study was conducted. A total of 30 patients were enrolled, who were randomized to either Group P: PECS1 block ( n = 15) or Group PT: PECS1 and TTM blocks ( n = 15). The intraoperative requirement of midazolam and local anesthetic and level of sedation by Ramsay sedation score were noted. The pain was assessed by visual analog scale (VAS) at rest and during a cough or deep breathing at 0 h, 3 h, 6 h, 12 h, and 24 h after the procedure. Results: VAS scores at rest were significantly lower in group PT at 0, 3, 6, and 12 h postprocedure, and during cough at 0, 6, and 12 h after the procedure ( P < 0.05). At 24 h, VAS scores were comparable between both groups. Intraoperative midazolam consumption was higher in group P compared to group PT ( P = 0.002). Fourteen patients in group P received local anesthetic supplementation in comparison to only one patient in group PT ( P = 0.0001). Thirteen patients in group P received the first rescue analgesia in comparison to three patients in group PT ( P = 0.0003). Conclusion: Combined PECS1 and TTM blocks provide superior analgesia, reduced net consumption of local anesthetic, sedative agents, and rescue analgesics compared to PECS1 block alone in patients undergoing CIED insertion.

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“…Using regression analysis, it was found that the use of intraoperative fentanyl and a longer time spent in the procedure were significant predictors of more intense postoperative pain. The mean VAS score for pain at one month was 19 ± 18 and 17 out of 21 patients rated this pain as "mild" [6].…”

Section: Risk Factors For Postoperative Painmentioning

confidence: 98%

Postoperative Pain Control Following Cardiac Implantable Electronic Device Implantation

Magnusson¹,

LeQuang²,

Pergolizzi³

2022

Cardiac Rhythm Management - Pacing, Ablation, Devices

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Postoperative pain following cardiac implantable electronic device (CIED) surgery may not always be adequately treated. The postoperative pain trajectory occurs over several days following the procedure with tenderness and limited arm range of motion lasting for weeks after surgery. Pain control typically commences in the perioperative period while the patient is in the hospital and may continue after discharge; outpatients may be given a prescription and advice for their analgesic regimen. It is not unusual for CIED patients to be discharged a few hours after implantation. While opioids are known as an effective analgesic to manage acute postoperative pain, growing scrutiny on opioid use as well as their side effects and potential risks have limited their use. Opioids may be considered for appropriate patients for a short course of treatment of acute postoperative pain, but other analgesics may likewise be considered.

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Patient Discomfort Following Pectoral Defibrillator Implantation Using Conscious Sedation

Abstract: (1) Pectoral ICD implantation using conscious sedation is well tolerated. (2) Postoperative discomfort correlates with longer procedural times and larger intraoperative narcotic requirements.

Cited by 8 publications

References 6 publications

Upper airway stimulation for obstructive sleep apnea: The surgical learning curve

Upper airway stimulation for obstructive sleep apnea: The surgical learning curve

Comparison of pectoral Nerve (PECS1) block with combined PECS1 and transversus thoracis muscle (TTM) block in patients undergoing cardiac implantable electronic device insertion – A pilot study

Postoperative Pain Control Following Cardiac Implantable Electronic Device Implantation

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