Ultrasound-guided serratus anterior plane block combined with parasternal block in subcutaneous implantable cardioverter defibrillator implantation: Results of a pilot study.

Autor: Uran C; Cardiology and Intensive Care Unit, 'San Giuseppe e Melorio' Hospital, Santa Maria Capua Vetere, Italy., Giojelli A; Diagnostic Imaging Unit, 'San Giuseppe e Melorio' Hospital, Santa Maria Capua Vetere, Italy., Borgogna DA; Anesthesia and Intensive Care Unit, 'San Giuseppe e Melorio' Hospital, Santa Maria Capua Vetere, Italy., Morello G; Cardiology and Intensive Care Unit, 'San Giuseppe e Melorio' Hospital, Santa Maria Capua Vetere, Italy., Marullo F; Cardiology and Intensive Care Unit, 'San Giuseppe e Melorio' Hospital, Santa Maria Capua Vetere, Italy., Iodice P; Cardiology and Intensive Care Unit, 'San Giuseppe e Melorio' Hospital, Santa Maria Capua Vetere, Italy., Greco A; Anesthesia and Intensive Care Unit, 'Card. Giovanni Panico' Hospital, Tricase, Italy., Accogli M; Cardiology Unit, 'Card. Giovanni Panico' Hospital, Tricase, Italy., Guido A; Cardiology Unit, 'Card. Giovanni Panico' Hospital, Tricase, Italy., Palmisano P; Cardiology Unit, 'Card. Giovanni Panico' Hospital, Tricase, Italy.
Jazyk: angličtina
Zdroj: Pacing and clinical electrophysiology : PACE [Pacing Clin Electrophysiol] 2020 Jul; Vol. 43 (7), pp. 705-712. Date of Electronic Publication: 2020 Jun 03.
DOI: 10.1111/pace.13944
Abstrakt: Background: The standard approach to subcutaneous defibrillator (S-ICD) implantation often requires general anesthesia or anesthesiologist-delivered deep sedation. Ultrasound-guided serratus anterior plane block (SAPB) combined with parasternal block (PSB) has been proposed in order to provide anesthesia/analgesia and to reduce the need for sedation during S-ICD implantation. In this pilot study, we compared the double-block approach (SAPB + PSB) with the single-block approach (SAPB only) and with the standard approach involving local anesthesia and sedation.
Methods: We prospectively enrolled 22 patients undergoing S-ICD implantation: in 10, the single-block approach was adopted; in 12, the double-block approach. As a control group, we retrospectively enrolled 14 consecutive patients who had undergone S-ICD implantation under standard local anesthesia and sedation in the previous 6 months. Intra- and postprocedural data, including patient-reported pain intensity, were collected and compared in the three study groups.
Results: The double-block approach was associated with a shorter procedure duration than the single-block and standard approaches (63.3 ± 7.9 vs 70.1 ± 6.8 vs 76.9 ± 7.8 min; P < .05) and with a lower dose of local an aesthetic for infiltration (18.9 ± 1.7 vs 27.5 ± 4.6 vs 44.6 ± 4.0 cc; P < .001). Both the double- and single-block approaches were associated with lower pain intensity at the device pocket and the lateral tunneling site (P < .05). The double-block approach proved superior to the other two approaches in controlling intraoperative pain at the parasternal tunneling site (P < .05).
Conclusions: In our study, SAPB combined with PSB was superior to SAPB alone and to the standard approach in controlling intraoperative pain during S-ICD implantation. In addition, this approach resulted in shorter procedure durations.
(© 2020 Wiley Periodicals LLC.)
Databáze: MEDLINE
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