Antiperovitch Pavel, Mokhtar Ahmed T, Yee Raymond, Manlucu Jaimie, Gula Lorne J, Leong-Sit Peter, Skanes Allan C, Tang Anthony S L, Khan Habib Rehman
London Health Sciences Center, University of Western Ontario, London, Ontario, Canada.
Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Pacing Clin Electrophysiol. 2023 Dec;46(12):1447-1454. doi: 10.1111/pace.14843. Epub 2023 Nov 23.
Cardiac implantable electronic devices (CIEDs) are routinely implanted using intravenous drugs for sedation. However, some patients are poor candidates for intravenous sedation.
We present a case series demonstrating the safety and efficacy of a novel, ultrasound-guided nerve block technique that allows for pre-pectoral CIED implantation. The targets are the supraclavicular nerve (SCN) and pectoral nerve (PECS1).
We enrolled 20 patients who were planned for new CIED implantation. Following US-localization of the SCN and PECS1, local anesthetic (LA) was instilled at least 30-60 min pre-procedure. Successful nerve block was determined if < 5 mL of intraprocedural LA was used, along with lack of sensation with skin and deep tissue pinprick. Optional sedation was offered to patients' pre-procedure if discomfort was reported.
Seventeen patients (85%) had a successful periprocedural nerve block, with only three patients exceeding 5 mL of LA. SCN and PECS1 success occurred in 19 (95%) and 18 (90%) patients, respectively. The overall success of nerve block by fulfilling all the criteria was demonstrated in 17 out of 20 patients (85%). Patients who reported no pain (VAS score = 0) were distributed as follows: 13 patients (65%) in the immediate post-procedure interval, 18 patients (90%) at the 1 h post-implant interval, and 14 patients (70%) at the 24 h post- implant interval. The median cumulative VAS score was 0 (IQR = 0 - 1). There were no reported significant adverse effects.
SCN and PECS1 nerve blocks are safe and effective for patients undergoing CIED implantation to minimize or eliminate the use of intravenous sedation.
心脏植入式电子设备（CIED）通常通过静脉注射药物进行镇静后植入。然而，一些患者并不适合静脉镇静。
我们展示了一系列病例，证明了一种新型超声引导神经阻滞技术在胸前区CIED植入中的安全性和有效性。靶点为锁骨上神经（SCN）和胸神经（PECS1）。
我们纳入了20例计划植入新CIED的患者。在超声定位SCN和PECS1后，在手术前至少30 - 60分钟注入局部麻醉剂（LA）。如果术中使用的LA少于5 mL，且皮肤和深部组织针刺无感觉，则判定神经阻滞成功。如果患者术前报告有不适，可提供选择性镇静。
17例患者（85%）围手术期神经阻滞成功，只有3例患者使用的LA超过5 mL。SCN和PECS1神经阻滞成功的患者分别为19例（95%）和18例（90%）。20例患者中有17例（85%）符合所有标准，神经阻滞总体成功。报告无疼痛（视觉模拟评分[VAS] = 0）的患者分布如下：术后即刻13例（65%），植入后1小时18例（90%），植入后24小时14例（70%）。VAS累积评分中位数为0（四分位间距 = 0 - 1）。未报告有明显不良反应。
SCN和PECS1神经阻滞对于接受CIED植入的患者安全有效，可减少或消除静脉镇静的使用。
