Ultrasound‐guided combined pectoral nerve block and axillary venipuncture for the implantation of cardiac implantable electronic devices

Abstract

Background:Combined ultrasound (US)-guided pectoral nerves (PECS) block and axillary vein (AV) puncture for cardiac implantable electronic devices can be effective to achieve optimal perioperative pain management and prevent access-related complications. Methods:A total of 36 patients who underwent combined US-guided PECS block and AV puncture were included. All routinely recorded parameters, including clinical and demographic characteristics, periprocedural medical administrations, the time taken for both PECS block and AV puncture, procedure time, postprocedural pain score, and procedure-related complications, were collected and analyzed. Results: In total, 54 leads were placed in 36 patients. The combined US-guided PECS block and AV puncture was performed successfully in 35 (97.2%) patients without the need for fluoroscopy or venography. AV access for each lead was achieved in a single attempt in 80.6% of cases. The time for both PECS block and AV puncture was 223.6 ± 52.1 s, including the time to apply incision site anesthesia. Additional sedatives and/or local anesthetics were required in two patients during procedure. Visual analog scale average of the patients in the 1st, 6th, and 24th h was 3.7 ± 1.14. 1.61 ± 1.29, and 0.08 ± 0.28, respectively. After the procedure, four patients (three of them woman) needed analgesics. There were no venous access-related complications. Conclusions: This new combined technique maintains both surgical and postoperative analgesia and prevents vascular access-related complications without significant increase on procedure time. K E Y W O R D S axillary vein, cardiac implantable electronic devices, pectoral nerve block, ultrasound, venous access 1 1026

Ultrasound guided percutaneous cephalic venipuncture for implantation of cardiac implantable electronic devices

“…[20][21][22] In our recently published report on axillary approach under ultrasound guidance, the success rate was 97.2% compared to 79.4% for CV access using US-guidance described here; neither technique was associated with any access-related complication. 10 In addition, the mean ± SD total time for PECS plus AV puncture was 223.6 ± 52.1, compared with 214.3 ± 26.4 seconds for PECS plus CV puncture described herein. This difference may be due to the CV being more superficial and thus easier to puncture.…”

“…The procedure has been described and illustrated previously. 10 Briefly, using fully aseptic precautions, the patient was placed in a supine position and a 6-13 MHz frequency linear US probe was placed at the mid-level of infra-clavicular region. Using pulse wave Doppler, the pectoralis muscles were identified and identification of the pectoral branch of the thoracoacromial artery was attempted.…”

A Novel Nerve Block Technique for a Patient Undergoing Cardiac Device Implantation

“…However, some patients are poor candidates for intravenous sedation, such as those who have not fasted, had documented anesthetic intolerance/reactions, are hemodynamically unstable or elderly, and those with neuromuscular diseases. 3 , 4 Nerve blocks have been previously reported to control postoperative pain in patients undergoing cardiac device implantation 5 , 6 , 7 ; however, pain control during the implantation procedure has always required intravenous sedation and local anesthetic administration. Here, we introduce a novel combination of the SCN and PECS 1 blocks, which are easy to learn, safe to perform, and provide highly effective anesthetic for patients during and after CIED implantation.…”

“…The deeper subcutaneous tissues and the tissue plane above the pectoralis major muscle are supplied by the medial and lateral PECSs, which can be anesthetized with a well-described PECS 1 block. 7 The SCN block anesthetizes the skin to a depth of one-half of the subcutaneous tissue to allow a painless surgical incision, and the PECS 1 block allows deeper dissection and the creation of the CIED pocket.…”

Ultrasound guided Interpectoral, Pectoserratus and Serratus anterior plane blocks

“…SAP block Breast surgery [3,4] + + Sentinel lymphe node and axillary dissection [25,26] + + Breast expander /submuscular prosthesis + + Implantation of cardiac device (pacemaker and defibrillator) or ports [27] + + Anterior thoracotomy [28] + + Rib fractures [29] -+ Thoracoscopy [24] -+…”