Ultrasound-guided serratus anterior plane block combined with the two-incision technique for subcutaneous ICD implantation.

BACKGROUND: The standard technique for implanting a subcutaneous implantable cardioverter defibrillator (S-ICD) requires three incisions and the pocket of the device is created in the subcutaneous tissue of the left lateral thoracic wall. However, a two-incision technique may be adopted, in which the cranial parasternal region is avoided and the device is positioned more deeply, completely under the latissimus dorsi muscle. This can also be combined with ultrasound-guided serratus anterior plane block (US-SAPB) for intraoperative anesthesia and perioperative analgesia. We describe our preliminary experience of US-SAPB combined with the two-incision intermuscular technique. METHODS: We performed US-SAPB 40 minutes before starting the procedure, while the patient was in the supine position. The devices were implanted under the latissimus dorsi muscle. All patients were followed-up after hospital discharge. RESULTS: Twelve patients (male 50%, 53 ± 16 years, body mass index 23 ± 4) underwent the S-ICD implantation with the combined technique. The mean procedure duration was 47 ± 11 minutes. The procedure was successful and a shock energy of 65 J was successful in converting the induced ventricular fibrillation in all patients. The US-SAPB was successful in 92% of cases and only one patient required convertion into general anesthesia due to pain during the procedure. In the postoperative period, patients did not report major discomfort and analgesics were not required. During a median follow-up of 12 months, no complications were reported. CONCLUSIONS: Serratus anterior plane block combined with the intermuscular and two-incision technique proved to be safe and effective during the S-ICD implantation procedure.

Ultrasound-Guided Transversalis Fascia Plane Block: An Alternative Approach for Anesthesia in Inguinal Herniorrhaphy: A Case Report.

Ultrasound (US)-guided transversalis fascia plane block (TFPB) was first described by Hebbard as a technique for blockade of T12-L1 nerves. Although this technique appears similar to the quadratus lumborum 1 block, the point of injection is more caudal and anterior, specifically targeting ilioinguinal and iliohypogastric nerves. There are only few published data on US-guided TFPB demonstrating effective postoperative analgesia in iliac crest bone graft harvesting. We report the use of US-guided TFPB in a patient undergoing inguinal herniorrhaphy. Our experience suggests that this technique could represent a viable alternative to general anesthesia and standard regional techniques for inguinal hernia repair.