Ultrasound-guided serratus anterior plane block combined with parasternal block in subcutaneous implantable cardioverter defibrillator implantation: Results of a pilot study.

BACKGROUND: The standard approach to subcutaneous defibrillator (S-ICD) implantation often requires general anaesthesia or anaesthesiologist-delivered deep sedation. Ultrasound-guided serratus anterior plane block (SAPB) combined with parasternal block (PSB) has been proposed in order to provide anaesthesia/analgesia and to reduce the need for sedation during S-ICD implantation. In this pilot study, we compared the double-block approach (SAPB+PSB) with the single-block approach (SAPB only) and with the standard approach involving local anaesthesia and sedation. METHODS: We prospectively enrolled 22 patients undergoing S-ICD implantation: in 10, the single-block approach was adopted; in 12, the double-block approach. As a control group, we retrospectively enrolled 14 consecutive patients who had undergone S-ICD implantation under standard local anaesthesia and sedation in the previous 6 months. Intra- and post-procedural data, including patient-reported pain intensity, were collected and compared in the 3 study groups. RESULTS: The double-block approach was associated with a shorter procedure duration than the single-block and standard approaches (63.3±7.9 vs. 70.1±6.8 vs. 76.9±7.8 min; p<0.05) and with a lower dose of local anaesthetic for infiltration (18.9±1.7 vs. 27.5±4.6 vs. 44.6±4.0 cc; p<0.001). Both the double- and single-block approaches were associated with lower pain intensity at the device pocket and the lateral tunnelling site (p<0.05). The double-block approach proved superior to the other two approaches in controlling intraoperative pain at the parasternal tunnelling site (p<0.05). CONCLUSIONS: In our study, SAPB combined with PSB was superior to SAPB alone and to the standard approach in controlling intra-operative pain during S-ICD implantation. In addition, this approach resulted in shorter procedure durations. This article is protected by copyright. All rights reserved.