Regional Anesthesia for the Implantation of a Subcutaneous Implantable Cardioverter-Defibrillator Using Pectoserratus Plane Block and Superficial Serratus Anterior Plane Block

Abstract

Background The combination of pectoserratus plane block (PSP) and superficial serratus anterior plane block (S-SAP) was established to reduce the risk of general anesthesia for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation in patients with high operative risk (American Society of Anesthesiologists [ASA] grade III or IV). This study compared outcomes from ultrasound-guided PSP and S-SAP in 16 patients requiring a subcutaneous implantable cardioverter-defibrillator (S-ICD) at a single center in Poland. Material/Methods A group of 16 patients with ASA grade III and IV qualified for S-ICD implantation was included. The pain assessment using numerical rating scale (NRS), patient’s comfort using Quality of Recovery-15 (QoR-15), the operator’s satisfaction using Operator’s Comfort Scale, adverse event occurrence, and the parameters’ stability were evaluated. Results The mean volume of the local anesthetics mixture of PSP block was 19.4 mL; S-SAP was 34.7 mL (mean total volume, 54.1 mL). The mean duration of the block was 21.3 min; the mean time of the S-ICD implantation was 108.4 min. Neither circulatory nor respiratory instability was observed. In 8 patients (50%), non-opioid analgesics were administered intraoperatively; in 11 patients (69%), fentanyl bolus ≤200 μg was administered. The intraoperative NRS score was low (max 2 points); NRS 24 h after the procedure was low (max 4 points). The mean value of QoR-15 was 133.9 points. Conclusions S-SAP combined with PSP is feasible and safe in providing anesthesia/analgesia during S-ICD implantation and showed good effects in a group of patients with high operative risk (ASA III or IV).

Serratus anterior plane block and postoperative pain control in obese patients undergoing S‐ICD implantation: A case series and literature analysis

“…However, the data available in the literature are mostly derived from case reports and small comparative studies. 23 Therefore, further studies with a larger sample size and direct comparison with general anesthesia or deep sedation are needed.…”

“…The positive effects include a lower hemodynamic impact, reduced opioid administration, and better patient compliance with the procedure. However, the data available in the literature are mostly derived from case reports and small comparative studies 23 . Therefore, further studies with a larger sample size and direct comparison with general anesthesia or deep sedation are needed.…”