Tumescent local anesthesia versus general anesthesia for subcutaneous implantable cardioverter-defibrillator implantation

Romero, Javier; Bello, J. A.; Díaz, Juan Carlos; Grushko, Michael; Velasco, Alejandro; Zhang, Xiaodong; Briceño, David; Gabr, Mohamed; Purkayastha, Sutopa; Polanco, Dalvert; Rocca, Domenico Della; Krumerman, Andrew; Palma, Eugen C.; Lakkireddy, Dhanunjaya; Biase, Luigi Di

doi:10.1016/j.hrthm.2021.03.008

Cited by 13 publications

(5 citation statements)

References 27 publications

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“…[21][22][23] Alternative strategies, such as tumescent local anesthesia, are also promising and should be considered especially in high-risk patients. 24 Patient education is critical so that patients anticipate a brief period of pain after their procedure and follow appropriate arm restrictions in the immediate postoperative period to reduce the risk of lead dislodgement but avoid prolonged, excessive immobilization, which can lead to adhesive capsulitis.…”

Section: Discussionmentioning

confidence: 99%

Persistent Opioid Use After Cardiac Implantable Electronic Device Procedures

et al. 2021

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Background: Prescription opioids are a major contributor to the ongoing epidemic of persistent opioid use (POU). The incidence of POU among opioid-naïve patients after cardiac implantable electronic device (CIED) procedures is unknown. Methods: This retrospective cohort study used data from a national administrative claims database from 2004 to 2018 of patients undergoing CIED procedures. Adult patients were included if they were opioid-naïve during the 180-day period before the procedure and did not undergo another procedure with anesthesia in the next 180 days. POU was defined by filling an additional opioid prescription >30 days after the CIED procedure. Results: Of the 143 400 patients who met the inclusion criteria, 15 316 (11%) filled an opioid prescription within 14 days of surgery. Among these patients, POU occurred in 1901 (12.4%) patients 30 to 180 days after surgery. The likelihood of developing POU was increased for patients who had a history of drug abuse (odds ratio, 1.52; P =0.005), preoperative muscle relaxant (odds ratio, 1.52; P <0.001) or benzodiazepine (odds ratio, 1.23; P =0.001) use, or opioid use in the previous 5 years (OR, 1.76; P <0.0001). POU did not differ after subcutaneous implantable cardioverter defibrillator or other CIED procedures (11.1 versus 12.4%; P =0.5). In a sensitivity analysis excluding high-risk patients who were discharged to a facility or who had a history of drug abuse or previous opioid, benzodiazepine, or muscle relaxant use, 8.9% of the remaining cohort had POU. Patients prescribed >135 mg of oral morphine equivalents had a significantly increased risk of POU. Conclusions: POU is common after CIED procedures, and 12% of patients continued to use opioids >30 days after surgery. Higher initially prescribed oral morphine equivalent doses were associated with developing POU.

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Section: Discussionmentioning

confidence: 99%

Persistent Opioid Use After Cardiac Implantable Electronic Device Procedures

et al. 2021

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“…Further novelty is added by combining the use of regional anesthesia, with peri-procedural intercostal nerve blockade, to the conscious sedation and local anesthesia protocols described previously [17]. It represents yet another avenue of regional anesthesia in a landscape that already includes serratus anterior plane block (SAPB) [25], thoracic paravertebral blockade [26], and tumescent local anesthesia [20]. Advantageously, unlike in thoracic paravertebral blockade, there is no need for anticoagulation or anti-thrombotic therapy to be suspended in intercostal nerve blockade.…”

Section: Discussionmentioning

confidence: 99%

“…Non-GA techniques, including monitored anesthesia care [17,18], regional anesthesia [18], nonanesthesiologist administered sedation and analgesia [17][18][19], and tumescent local anesthesia [20] have been extensively described in the literature. However, these studies have largely focused on describing implantation with these various anesthetic techniques, rather than speci cally comparing them to GA. One small single-center observational study did demonstrate the analgesic e cacy and safety of monitored anesthesia care relative to GA, though with a very limited sample size of 10 subjects [17].…”

Section: Introductionmentioning

confidence: 99%

General Anesthesia Versus Conscious Sedation With Locoregional Anesthesia in S-Icd Implantation: A Monocentric Retrospective Analysis

Marco¹,

J²,

Mondésert³

2021

Canadian Journal of Cardiology

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“…Tumescent local anesthesia is also used in cardiac implantable electronic device surgeries. We have previously described the application of TLA for pacemaker implantation (Kawatani & Hori, 2022), and Romero et al applied the technique for subcutaneous defibrillator implantation (Romero et al, 2021). This technique can provide a deeper, safer, and more accurate ICM implantation.…”

Section: Anesthesia and Implantation Techniquementioning

confidence: 99%

Correlation between the electrocardiogram amplitude detected by an implantable cardiac monitor and the implantation depth

Kawatani,

Hori

2023

Noninvasive Electrocardiol

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IntroductionImplantable cardiac monitors (ICMs) primarily use R‐R intervals in subcutaneous electrocardiograms (ECGs) to detect arrhythmias. Therefore, reliable detection of R‐wave amplitude by an ICM is vital. Since ICMs detect subcutaneous ECGs, the impact of the implantation depth should be assessed.Methods and ResultsThis study investigated the influence of ICM depth on R‐wave (ICM‐R) amplitude on an ECG generated by an ICM (JOT Dx; Abbott). Overall, 58 patients who underwent ICM implantation at Kamagaya General Hospital from May 2022 to April 2023 were retrospectively reviewed. The depth‐position was measured using ultrasound imaging after implantation. The depth of the ICM did not show any correlation with ICM‐R amplitude (r = −.0141, p = .294). However, the distance between the ICM and the heart surface showed a significant correlation with ICM‐R amplitude (r = −.581, p < .001). Body weight (r = −.0283, p = .033) and body mass index (r = −.0342, p = .009) were associated with ICM‐R amplitude. S wave in the V1‐lead was also associated with ICM‐R amplitude (r = .481, p < .001). After multivariate analysis, the distance between the ICM and heart surface and the S wave in V1 were independent determinants for the ICM‐R amplitude.ConclusionThe ICM‐R amplitude may be higher with the ICM implanted deeper.

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Tumescent local anesthesia versus general anesthesia for subcutaneous implantable cardioverter-defibrillator implantation

Cited by 13 publications

References 27 publications

Persistent Opioid Use After Cardiac Implantable Electronic Device Procedures

Persistent Opioid Use After Cardiac Implantable Electronic Device Procedures

General Anesthesia Versus Conscious Sedation With Locoregional Anesthesia in S-Icd Implantation: A Monocentric Retrospective Analysis

Correlation between the electrocardiogram amplitude detected by an implantable cardiac monitor and the implantation depth

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