Use of Serratus Anterior Plane and Transversus Thoracis Plane Blocks for Subcutaneous Implantable Cardioverter-Defibrillator (S-ICD) Implantation Decreases Intraoperative Opioid Requirements.

ABSTRACT

OBJECTIVES: The present study investigated whether regional anesthetic techniques, especially truncal blocks, can provide adjunct anesthesia without the additional risk of general anesthesia and neuraxial techniques for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation. DESIGN: Single-center, prospective, randomized study. SETTING: Holding area and operating room at a single-center tertiary care hospital. PARTICIPANTS: The study comprised 22 American Society of Anesthesiologists (ASA) physical status 3 or 4 patients with severe cardiac disease undergoing S-ICD implantation. INTERVENTIONS: Patients received either a combination of serratus anterior plane block and transversus thoracis plane block or surgical infiltration of local anesthetics. MEASUREMENTS AND MAIN RESULTS: Perioperative analgesic medication in the fascial plane block group versus the surgical wound infiltration group, visual analog pain scale score (0-10), intraoperative vital signs, total procedure time, and length of stay in the intensive care unit were measured. Total intraoperative fentanyl requirements (µg) were significantly less in the truncal block group versus the surgical infiltration group (45 [25-50] v 90 [50-100]; p = 0.026), and no patients had any adverse sequelae related to the study. Median intraoperative propofol use in the surgical infiltration group was 66.48 (47.30-73.73) µg/kg/min, and 65.95 (51.86-104.86) µg/kg/min for the truncal block group. This difference between the groups was not statistically significant (p = 0.293). CONCLUSIONS: The performance of both the serratus anterior plane block and transversus thoracis plane blocks for S-ICD implantation are appropriate and may have the benefit of decreasing intraoperative opioid requirements.