Feasibility of subcutaneous implantable cardioverter‐defibrillator implantation with opioid sparing truncal plane blocks and deep sedation

Miller, Marc A.; Garg, Jalaj; Salter, Benjamin; Brouwer, Thomas F.; Mittnacht, Alex J.; Montgomery, Morgan L.; Honikman, Rafael; Arkonac, Derya; Choudry, Subbarao; Dukkipati, Srinivas R.; Reddy, Vivek Y.; Weiner, Menachem M.

doi:10.1111/jce.13750

Cited by 18 publications

(9 citation statements)

References 26 publications

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“…Regional anesthesia techniques, such as truncal plane blocks ( Figure 4D), also may be a feasible alternative to general anesthesia for subcutaneous ICD implantation. 27 For transvenous pacemakers or defibrillators, local anesthetic infiltration is adequate, although cervical and pectoral nerve block may be an alternative option. 28,29 Intravenous ketamine has been suggested to reduce postoperative opioid use.…”

Section: Discussionmentioning

confidence: 99%

Postoperative opioid prescription patterns and new opioid refills following cardiac implantable electronic device procedures

et al. 2019

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BACKGROUND Prescription opioids are a major cause of the opioid epidemic. Despite the invasive nature of cardiac implantable electronic device (CIED) procedures, data on opioid prescription patterns after CIED procedures are lacking. OBJECTIVE The purpose of this study was to assess opioid prescribing patterns and the rates of new opioid refills (refills in previously opioid naïve patients) among patients undergoing CIED procedures. METHODS We performed a retrospective analysis of all patients undergoing CIED procedures from January 1, 2010, to March 30, 2018, at the Mayo Clinic (Minnesota, Arizona, and Florida). Procedures were categorized into new implant, generator change, device upgrade, lead revision or replacement, and subcutaneous implantable cardiac defibrillator (S-ICD) procedures. The rates of postoperative opioid prescription and new opioid refills were analyzed. Wilcoxon rank sum and c 2 tests assessed variations. RESULTS A total of 16,517 patients (mean age 70 6 15; 36% female) underwent CIED procedures. Opioids were prescribed to 20.2% of the patients, among whom 80% were opioid naïve. Among opioid naïve patients who received opioids, 9.4% (95% confidence interval [CI] 8.3%-10.5%) had subsequent opioid refills. The percentage of patients who received more than 200 oral morphine equivalents of prescription was 38.8% (95% CI 37.2%-40.5%). Temporal trends revealed increasing rates of any opioid prescription, peaking in 2015 at 25.9%, with subsequent downtrend to 14.6% in 2018 (P ,.001). CONCLUSION Postoperative opioid prescription rate after CIED procedures was 20.2%, with most patients being opioid naïve. Among opioid naïve patients who received opioids, 9.4% had subsequent opioid refills. This finding suggests that perioperative pain management in CIED procedures warrants meticulous attention.

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Section: Discussionmentioning

confidence: 99%

Postoperative opioid prescription patterns and new opioid refills following cardiac implantable electronic device procedures

et al. 2019

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“…Finally, the combination of preoperatively administered oral acetaminophen and gabapentin with unconscious sedation and muscular plane block showed lower perioperative opioid consumption compared to GA plus muscular plane block 27 . Of note, any multimodal anesthetic regime is complex and needs the expertise of an anesthesiologist.…”

Section: Implantation Issues Of Ntv‐icdmentioning

confidence: 95%

State‐of‐the‐art consensus on non‐transvenous implantable cardioverter‐defibrillator therapy

Schukro

Santer

Prenner

et al. 2020

Clinical Cardiology

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Within the last decade, implantable cardioverter-defibrillator (ICD) systems with nontransvenous leads were developed in order to minimize complications related to the cardiovascular position of transvenous ICD leads. This national expert consensus gives an overview of potential indications for the implantation of non-transvenous ICD systems, and provides specific recommendations for implantation, follow-up, and complication management in patients with subcutaneous ICD. Regarding particular issues like the necessity for shock efficacy testing, or the clinical outcome as compared to transvenous ICD, randomized data are expected in the near future.

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“…Monitored anesthesia care (MAC) has been reported in the literature to be a safe and effective method for subcutaneous ICD implantation [10,11]. The truncal plane block along with perioperative nonopioid analgesics is being considered and appears feasible and effective [12]. A study of 91 consecutive patients undergoing subcutaneous ICD implantation at 10 centers found ultrasound-guided serratus anterior plane block was effective for anesthesia during the procedure and postoperative analgesia [13].…”

Section: Subcutaneous Icdsmentioning

confidence: 99%

“…Liposomal bupivacaine extended-release formulation may provide good anesthetic infiltration with an effect that can last up to 72 hours [47]. In some cases, general anesthesia is used but truncal plane blocks may also provide adequate anesthesia for difficult procedures or those involving a subcutaneous device [12]. For conventional ICDs and devices with transvenous lead systems, local anesthetic infiltration is probably adequate, but sometimes cervical or pectoral nerve block may be employed [48,49].…”

Section: Perioperativementioning

confidence: 99%

Postoperative Pain Control Following Cardiac Implantable Electronic Device Implantation

Magnusson¹,

LeQuang²,

Pergolizzi³

2022

Cardiac Rhythm Management - Pacing, Ablation, Devices

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Postoperative pain following cardiac implantable electronic device (CIED) surgery may not always be adequately treated. The postoperative pain trajectory occurs over several days following the procedure with tenderness and limited arm range of motion lasting for weeks after surgery. Pain control typically commences in the perioperative period while the patient is in the hospital and may continue after discharge; outpatients may be given a prescription and advice for their analgesic regimen. It is not unusual for CIED patients to be discharged a few hours after implantation. While opioids are known as an effective analgesic to manage acute postoperative pain, growing scrutiny on opioid use as well as their side effects and potential risks have limited their use. Opioids may be considered for appropriate patients for a short course of treatment of acute postoperative pain, but other analgesics may likewise be considered.

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Feasibility of subcutaneous implantable cardioverter‐defibrillator implantation with opioid sparing truncal plane blocks and deep sedation

Abstract: Subcutaneous ICD implantation with anesthesia-delivered DS and a multimodal anesthetic regimen that includes TBL is feasible and associated with significantly less perioperative opioid consumption.

Cited by 18 publications

References 26 publications

Postoperative opioid prescription patterns and new opioid refills following cardiac implantable electronic device procedures

Postoperative opioid prescription patterns and new opioid refills following cardiac implantable electronic device procedures

State‐of‐the‐art consensus on non‐transvenous implantable cardioverter‐defibrillator therapy

Postoperative Pain Control Following Cardiac Implantable Electronic Device Implantation

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