Subpectoral pacemaker implantation under tumescent local analgesia

Abstract

Tumescent local analgesia (TLA) is an anesthetic technique used for inducing local analgesia over large areas and is rarely used in cardiothoracic surgery. An 83-year-old, extremely thin woman was hospitalized with sick sinus syndrome, requiring pacemaker implantation. We chose a subpectoral mode of implantation to prevent skin complications. General anesthesia was deemed risky due to the history of chronic pulmonary disease; therefore, the operation was successfully performed under TLA. Moreover, TLA helped introduce a subpectoral pocket for implanting the pacemaker with minimal trauma and bleeding. The analgesia was sufficient, with minimal postoperative pain, and required no additional sedatives and analgesics. The patient was discharged without any complications.

Tumescent local anesthesia for subcutaneous implantable cardioverter-defibrillator implantation: An alternative for general anesthesia

“…Recently, TLA has been used in the placement of a subpectoral pacemaker. 11 Some benefits related to TLA are reduced procedural times and reduced postprocedural pain reported by patients. 6 Also, the epinephrine-induced vasoconstriction decreases the risk of bleeding and therefore the risk of hematoma formation and infections.…”

High‐efficiency LC‐S compensated wireless power transfer charging converter for implantable pacemakers

“…35 It is recommended that the pocket can be placed beneath the major pectoralis muscle, especially in Japanese individuals. 36 In Kawatani et al, 33 the thickness of subcutaneous tissue is measured as 2.6 mm, while pectoralis major muscle has 5.6 mm thickness in the ultrasound examination. Thus, the total thickness is around 8.2 mm from the outer skin to the bottom of the pectoralis major muscle.…”

“…The skin, fat, and muscle tissues are taken into consideration in the determination of 8 mm distance between the coupling coils. In the real application, the pacemaker is usually inserted in pectoral region in a pocket under subcutaneous tissue 33,34 . The pocket lies just above the pectoral fascia.…”

“…In the real application, the pacemaker is usually inserted in pectoral region in a pocket under subcutaneous tissue. 33,34 The pocket lies just above the pectoral fascia. Sometimes, subcutaneous pocket insertion causes pocket erosion.…”

Three‐step tumescent local anesthesia technique for inguinal hernia repair

“…Tumescent local anesthesia (TLA) is a variant form of local anesthesia in which a large volume of diluted solution of local anesthetic and epinephrine is injected into the tissue. The TLA method has been utilized in various surgical procedures, such as liposuction, 1 varicose vein treatment, 2 and cardiac pacemaker implantation 3 . However, applying TLA to inguinal hernia repair has been reported only by a limited number of authors 4–6 .…”