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

Abstract

Background The standard approach to subcutaneous defibrillator (S‐ICD) implantation often requires general anaesthesia or anaesthesiologist‐delivered deep sedation. Ultrasound‐guided serratus anterior plane block (SAPB) combined with parasternal block (PSB) has been proposed in order to provide anaesthesia/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 anaesthesia 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 anaesthesia and sedation in the previous 6 months. Intra‐ and post‐procedural data, including patient‐reported pain intensity, were collected and compared in the 3 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<0.05) and with a lower dose of local anaesthetic for infiltration (18.9±1.7 vs. 27.5±4.6 vs. 44.6±4.0 cc; p<0.001). Both the double‐ and single‐block approaches were associated with lower pain intensity at the device pocket and the lateral tunnelling site (p<0.05). The double‐block approach proved superior to the other two approaches in controlling intraoperative pain at the parasternal tunnelling site (p<0.05). Conclusions In our study, SAPB combined with PSB was superior to SAPB alone and to the standard approach in controlling intra‐operative pain during S‐ICD implantation. In addition, this approach resulted in shorter procedure durations. This article is protected by copyright. All rights reserved