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.
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.
© 2022 Published by Elsevier Inc.