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Canadian Journal of Cardiology

EFFICACY AND SAFTEY OF SUPRACLAVICULAR AND PECTORALIS NERVE BLOCKS AS PRIMARY PERI-PROCEDURAL ANALGESIA FOR CARDIAC ELECTRONIC DEVICE IMPLANTATION: A PILOT STUDY

      Background

      Cardiac implantable electronic devices (CIED) are routinely implanted using intravenous drugs for sedation. However, some patients are poor candidates for intravenous sedation. We present a case series that demonstrates the safety and efficacy of a novel, ultrasound-guided nerve block technique that allows for pre-pectoral CIED implantation in high-risk patients. The targets are the supraclavicular nerve (SCN) and pectoral nerve (PECs1).

      Methods and Results

      We enrolled 20 patients who were planned for a new CIED implantation at LHSC. Following ultrasound guided-localization of the SCN and PECS1, local anesthetic (LA) was instilled at least 30-60 minutes pre-procedure. Successful nerve block was determined if less than 5ml local anesthetic was used intraprocedurally, in addition to lack of sharp sensation with skin (SCN) and deep tissue pin-prick (PECS1). The majority of patients (n=17, 85%) had successful periprocedural nerve block, with only 3 patients exceeding 5ml of LA. SCN and PECS1 success occurred in 19 (95%) and 19 (95%) patients, respectively. Only 8 patients (40%) received IV midazolam (mean dose 1.07 mg, SD ± 0.6) and fentanyl (mean dose 35.7mcg, SD ± 13.3) With the exception of 1 patient, all patients reported a low Visual Analogue Score (0-2) immediately after, at 1 hr and 1 day post-procedure. There were no reported major adverse effects.

      Conclusion

      SCN and PECS1 nerve block is safe and effective for patients undergoing CIED implantation to minimize or eliminate the use of intravenous sedation. A comparison study with the standard of care is needed to assess whether routine use of this technique improves patient outcomes.