Ultrasound-Guided Pectoserratus Plane Block and Superficial Serratus Anterior Plane Block for Subcutaneous Implantable Cardioverter-Defibrillator Implantation: A Comparative Study

Abstract

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).

Figure 1

Flow diagram of the study participants.

Figure 2

(A, C) Ultrasound transducer positioning and direction of the needle during the pectoserratus plane block (PSP) and (B, D) superficial serratus anterior plane block (S-SAP).

Figure 3

Area covered by the pectoserratus plane block (PSP) and superficial serratus anterior plane block (S-SAP): green lines indicate skin incision lines during subcutaneous cardioverter-defibrillator implantation.

Figure 4

Implantation of the subcutaneous cardioverter-defibrillator (S-ICD). Insertion of the subcutaneous electrode and its tunnel leading into the axillary area, where the S-ICD can be implanted: (A) marked with a circle; (B) implantation of the cardioverter-defibrillator body into the pocket in the axillary line.

Figure 5

(A, B) Intraoperative electrocardiogram findings.