Thoracic paravertebral block for implantable cardioverter-defibrillator and laser lead extraction

Tsai, Tony P.; Rodriguez-Diaz, César; Deschner, Bonnie; Thomas, Kurian; Wasnick, John D.

doi:10.1016/j.jclinane.2008.01.012

Cited by 10 publications

(4 citation statements)

References 14 publications

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“…observed that thoracic paravertebral block with sedation provided good analgesia in a 51-year-old male scheduled for removal of infected ICD and laser lead extraction. [ 13 ] But it has inherent risks associated with it in anticoagulated patients and demands more technical expertise. In contrast, truncal plane blocks are relatively easy to perform and provide excellent analgesia with a good safety profile.…”

Section: Discussionmentioning

confidence: 99%

Comparison of pectoral Nerve (PECS1) block with combined PECS1 and transversus thoracis muscle (TTM) block in patients undergoing cardiac implantable electronic device insertion – A pilot study

Nagaraja¹,

Arasu²,

Ragavendran³

et al. 2020

Ann Card Anaesth

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Background: Pectoral nerve (PECS1) block has been used for patients undergoing cardiac implantable electronic device (CIED) insertions, however, PECS1 block alone may lead to inadequate analgesia during tunneling and pocket creation because of the highly innervated chest wall. Transversus thoracis muscle plane (TTM) block targeting the anterior branches of T2-T6 intercostal nerves can be effectively used in combination with PECS1 for patients undergoing CIED insertion. The present study hypothesized that combined PECS1 and TTM blocks would provide effective analgesia for patients undergoing CIED insertion compared to PECS1 block alone. Materials and Methods: Thirty adult patients between the age group of 18–85 years undergoing CIED insertion were enrolled in the study. A prospective, randomized, comparative, pilot study was conducted. A total of 30 patients were enrolled, who were randomized to either Group P: PECS1 block ( n = 15) or Group PT: PECS1 and TTM blocks ( n = 15). The intraoperative requirement of midazolam and local anesthetic and level of sedation by Ramsay sedation score were noted. The pain was assessed by visual analog scale (VAS) at rest and during a cough or deep breathing at 0 h, 3 h, 6 h, 12 h, and 24 h after the procedure. Results: VAS scores at rest were significantly lower in group PT at 0, 3, 6, and 12 h postprocedure, and during cough at 0, 6, and 12 h after the procedure ( P < 0.05). At 24 h, VAS scores were comparable between both groups. Intraoperative midazolam consumption was higher in group P compared to group PT ( P = 0.002). Fourteen patients in group P received local anesthetic supplementation in comparison to only one patient in group PT ( P = 0.0001). Thirteen patients in group P received the first rescue analgesia in comparison to three patients in group PT ( P = 0.0003). Conclusion: Combined PECS1 and TTM blocks provide superior analgesia, reduced net consumption of local anesthetic, sedative agents, and rescue analgesics compared to PECS1 block alone in patients undergoing CIED insertion.

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Section: Discussionmentioning

confidence: 99%

Comparison of pectoral Nerve (PECS1) block with combined PECS1 and transversus thoracis muscle (TTM) block in patients undergoing cardiac implantable electronic device insertion – A pilot study

Nagaraja¹,

Arasu²,

Ragavendran³

et al. 2020

Ann Card Anaesth

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“…30,31 An informal email survey I conducted among 10 to 12 cardiac anesthesiologists performing this procedure in their hospitals suggests that practices vary widely. Most correspondents indicated that cardiothoracic anesthesiology is present for these procedures, and most use general anesthesia rather than sedation.…”

Section: Anesthetic Considerationsmentioning

confidence: 99%

Update on Cardiac Anesthesia

Gravlee¹

2012

ASA Refresher Courses in Anesthesiology

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“…Different strategies have been proposed including local anaesthesia alone 7 or regional anaesthesia techniques. 8,9 For the past few years, most authors have suggested a combination of sedation and local anaesthesia. [10][11][12][13] However, anaesthetic supervision and practice vary widely among centres.…”

Section: Introductionmentioning

confidence: 99%