Intraoperative ultrasound-guided pectoral nerve blocks for cardiac implantable device procedures.

Autor: Patel NA; Cardiac Electrophysiology, University of Pennsylvania, Philadelphia, PA, USA., Lin D; Cardiac Electrophysiology, University of Pennsylvania, Philadelphia, PA, USA., Ha B; Department of Anesthesiology, University of Pennsylvania, Philadelphia, PA, USA., Hyman MC; Cardiac Electrophysiology, University of Pennsylvania, Philadelphia, PA, USA., Nazarian S; Cardiac Electrophysiology, University of Pennsylvania, Philadelphia, PA, USA., Frankel DS; Cardiac Electrophysiology, University of Pennsylvania, Philadelphia, PA, USA., Epstein AE; Cardiac Electrophysiology, University of Pennsylvania, Philadelphia, PA, USA., Marchlinski FE; Cardiac Electrophysiology, University of Pennsylvania, Philadelphia, PA, USA., Markman TM; Cardiac Electrophysiology, University of Pennsylvania, Philadelphia, PA, USA. Timothy.markman@pennmedicine.upenn.edu.
Jazyk: angličtina
Zdroj: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2024 Sep; Vol. 67 (6), pp. 1353-1357. Date of Electronic Publication: 2023 Dec 18.
DOI: 10.1007/s10840-023-01724-4
Abstrakt: Background: Pectoral nerve (PECs) blocks are established regional anesthesia techniques that can provide analgesia to the anterior chest wall. Although commonly performed preoperatively by anesthesiologists, the feasibility of electrophysiologist-performed PECs blocks from within cardiac implantable electronic device (CIED) pockets at the time of implantation has not been established. The objective of this study is to assess the feasibility of routine PECs blocks performed by the electrophysiologist from within the exposed device pocket at the time of CIED procedures.
Methods: Patients undergoing CIED procedures underwent a PECs I block (15 cc of 1% lidocaine/0.25% bupivacaine) injected between the pectoralis major and minor muscles guided by ultrasound placed in the device pocket, or PECs II block, which included a second injection (15 cc) between pectoralis minor and serratus anterior muscles. Postoperatively, pain was assessed on a numeric scale (0-10) at 1, 2, 4, and 24 h, and 2 weeks after the procedure.
Results: Among 20 patients (age 65 ± 16 years, 70% male, 55% with history of chronic pain), PECs I (75%) and PECs II (25%) blocks were performed. The procedures were de novo implantation (n = 17) or device revision (n = 3). The average pain score in the first 4 h was 0.4 ± 0.8 and 0.3 ± 0.6 at 24 h after the procedure. During the 24-h postoperative period, 4 patients received opioids. Two patients were discharged with opioids for pain unrelated to the procedure.
Conclusions: Intraoperative PECs blocks can be feasibly performed from within an exposed pocket at the time of CIED procedures with minimal postoperative pain.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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