Kilin Mustafa, Kavakli Ali Sait, Karaveli Arzu, Sugur Tayfun, Kus Gorkem, Cagirci Goksel, Arslan Sakir
Department of Anesthesiology and Reanimation, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey.
Department of Anesthesiology and Reanimation, Istinye University Faculty of Medicine, Istanbul, Turkey.
Pacing Clin Electrophysiol. 2023 Oct;46(10):1251-1257. doi: 10.1111/pace.14811. Epub 2023 Sep 4.
Some truncal blocks could provide adequate surgical anesthesia and postoperative analgesia in cardiac implantable electronic devices (CIED) insertion. The aim of this study was to evaluate the feasibility of the pectoral nerves (PECS) II block for CIED insertion.
PECS II blocks were performed on the left side using the ultrasound-guided single injection technique in all patients. The primary outcome for feasibility was the percentage of the cases completed without intraoperative additional local anesthesia. Secondary outcomes were the amount of intraoperative additional local anesthetic, intraoperative opioid requirement, postoperative pain scores, first requirement for postoperative analgesia, postoperative analgesic consumption, patient satisfaction, and block-related complications.
Of the total 30 patients, 19 (63.3%) required intraoperative additional local anesthetic. The median (IQR [range]) volume of the additional local anesthetic used was 7 (4-10 [2.5-12]) mL. Two patients needed additional IV analgesics in the first 24 h postoperatively. No statistically significant differences were determined between the patients requiring and not requiring intraoperative additional local anesthetic in respect of age, gender, duration of surgery, block performance time, and hospital stay. A total of 26 (86.6%) patients reported a high level of satisfaction with the procedure.
PECS II block for cardiac electronic implantable device insertion provides effective postoperative analgesia for at least 24 h. Although PECS II block alone could not provide complete surgical anesthesia in the majority of the patients, when combined with supplementary local anesthetic, contributes to a smooth intraoperative course for patients.
一些躯干阻滞可为心脏植入式电子设备（CIED）植入术提供充分的手术麻醉和术后镇痛。本研究旨在评估胸神经（PECS）Ⅱ阻滞用于CIED植入术的可行性。
所有患者均采用超声引导下单次注射技术在左侧进行PECSⅡ阻滞。可行性的主要结局是无需术中追加局部麻醉即可完成手术的病例百分比。次要结局包括术中追加局部麻醉药的用量、术中阿片类药物需求量、术后疼痛评分、首次术后镇痛需求、术后镇痛药物消耗量、患者满意度以及与阻滞相关的并发症。
30例患者中，19例（63.3%）术中需要追加局部麻醉药。追加局部麻醉药的中位（IQR[范围]）用量为7（4 - 10[2.5 - 12]）mL。2例患者术后24小时内需追加静脉镇痛药。在年龄、性别、手术时长、阻滞操作时间和住院时间方面，术中需要和不需要追加局部麻醉药的患者之间未发现统计学显著差异。共有26例（86.6%）患者对该操作表示高度满意。
用于心脏电子植入设备植入术的PECSⅡ阻滞可提供至少24小时的有效术后镇痛。虽然单独的PECSⅡ阻滞在大多数患者中不能提供完全的手术麻醉，但与补充局部麻醉药联合使用时，有助于患者术中过程顺利。
