Department of Anaesthesiology and Intensive Therapy, 4th Military Clinical Hospital, Wrocław, Poland.
Department of Vascular Surgery, 4th Military Clinical Hospital, Wrocław, Poland.
Med Sci Monit. 2023 Jul 21;29:e940541. doi: 10.12659/MSM.940541.
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 Anesthesiologistsgrade 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 AND 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).
为降低高手术风险（美国麻醉医师协会分级 III 或 IV 级）患者行皮下植入式心律转复除颤器（S-ICD）植入术的全身麻醉风险，建立了胸小肌平面阻滞（PSP）与前锯肌浅面阻滞（S-SAP）联合阻滞技术。本研究比较了波兰一家单中心的 16 例行 S-ICD 植入术的患者行超声引导下 PSP 和 S-SAP 的结果。
纳入 16 例美国麻醉医师协会分级 III 和 IV 级患者，符合 S-ICD 植入条件。采用数字评分法（NRS）评估疼痛，采用 15 项术后恢复质量评分（QoR-15）评估患者舒适度，采用操作者舒适度评分（Operator's Comfort Scale）评估操作者满意度，评估不良事件发生情况及参数稳定性。
PSP 阻滞的局部麻醉药混合液平均用量为 19.4 mL；S-SAP 为 34.7 mL（平均总容量为 54.1 mL）。阻滞平均持续时间为 21.3 分钟；S-ICD 植入平均时间为 108.4 分钟。未观察到循环或呼吸不稳定。8 例（50%）患者术中给予非阿片类镇痛药；11 例（69%）患者给予舒芬太尼负荷量≤200 μg。术中 NRS 评分低（最高 2 分）；术后 24 小时 NRS 评分低（最高 4 分）。QoR-15 的平均得分为 133.9 分。
S-SAP 联合 PSP 用于 S-ICD 植入术麻醉/镇痛是可行且安全的，在高手术风险（ASA III 或 IV 级）患者中效果良好。
