Efficacy and safety of supraclavicular and pectoralis nerve blocks as primary peri‐procedural analgesia for cardiac electronic device implantation: A pilot study

Abstract

BackgroundCardiac implantable electronic devices (CIEDs) are routinely implanted using intravenous drugs for sedation. However, some patients are poor candidates for intravenous sedation.ObjectiveWe 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).MethodsWe 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.ResultsSeventeen 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.ConclusionSCN and PECS1 nerve blocks are safe and effective for patients undergoing CIED implantation to minimize or eliminate the use of intravenous sedation.