S-ICD implantation under the serratus plane block and transversus thoracis muscle plane block. A clinical case.

INTRODUCTION: The development of a subcutaneous implantable cardioverter-defibrillator (S-ICD) combined with the typical patient comorbidities creates new challenges for anaesthesia. CLINICAL CASE: A young male, ASA II, was proposed for S-ICD placement, after recovery from a sudden CRP episode. We performed regional anaesthesia with a serratus plane block (SPB) and transversus thoracic muscle plane block (TTPB) with administration of Mepivacaine and Ropivacaine. S-ICD placement was achieved under regional anaesthesia. In the perioperative period, the patient remained hemodynamically stable, without any complications or pain. DISCUSSION: The implantation of the ICD occurs in fragile patients, with high anaesthetic risk. In this case, the association of SPB and TTPB was an effective anaesthetic/analgesic approach, has advantages when compared with other techniques and has potential use in other procedures.

Implantación subcutánea de DCI-S mediante bloqueos del plano del músculo serrato y del músculo torácico transverso. Caso clínico / S-ICD implantation under the serratus plane block and transversus thoracis muscle plane block. A clinical case

Introducción: El desarrollo de un desfibrilador-cardioversor implantable subcutáneo (DCI-S), combinado con las comorbilidades normales del paciente crea nuevos retos en anestesia. Caso clínico: Varón joven, ASA II, propuesto para implantación de DCI-S, tras recuperarse de un episodio de parada cardiaca súbita. Realizamos anestesia regional con bloqueo en el plano del músculo serrato y bloqueo del plano del músculo torácico transverso con administración de mepivacaína y ropivacaína. La implantación de DCI-S se logró bajo anestesia regional. En el periodo perioperatorio el paciente permaneció hemodinámicamente estable, sin complicaciones ni dolor. Discusión: La implantación de DCI se produce en pacientes frágiles, con alto riesgo anestésico. En este caso, la asociación de bloqueo en el plano del músculo serrato y bloqueo del plano del músculo torácico transverso fue una técnica anestésica/analgésica efectiva, con ventajas en comparación con otras técnicas, y uso potencial en otros procedimientos.(AU)

Introduction: The development of a subcutaneous implantable cardioverter-defibrillator (S-ICD) combined with the typical patient comorbidities creates new challenges for anesthesia. Clinical case: A young male, ASA II, was proposed for S-ICD placement, after recovery from a sudden CRP episode. We performed regional anesthesia with a serratus plane block and transversus thoracic muscle plane block with administration of mepivacaine and ropivacaine. S-ICD placement was achieved under regional anesthesia. In the perioperative period, the patient remained hemodynamically stable, without any complications or pain. Discussion: The implantation of the ICD occurs in fragile patients, with high anesthetic risk. In this case, the association of serratus plane block and transversus thoracic muscle plane block was an effective anesthetic/analgesic approach, has advantages when compared with other techniques and has potential use in other procedures.(AU)

S-ICD implantation under the serratus plane block and transversus thoracis muscle plane block. A clinical case. / Implantación subcutánea de DCI-S mediante bloqueos del plano del músculo serrato y del músculo torácico transverso. Caso clínico.

INTRODUCTION: The development of a subcutaneous implantable cardioverter-defibrillator (S-ICD) combined with the typical patient comorbidities creates new challenges for anesthesia. CLINICAL CASE: A young male, ASA II, was proposed for S-ICD placement, after recovery from a sudden CRP episode. We performed regional anesthesia with a serratus plane block and transversus thoracic muscle plane block with administration of mepivacaine and ropivacaine. S-ICD placement was achieved under regional anesthesia. In the perioperative period, the patient remained hemodynamically stable, without any complications or pain. DISCUSSION: The implantation of the ICD occurs in fragile patients, with high anesthetic risk. In this case, the association of serratus plane block and transversus thoracic muscle plane block was an effective anesthetic/analgesic approach, has advantages when compared with other techniques and has potential use in other procedures.

Bloqueo lumbar del plano del músculo erector de la columna: control exitoso del dolor agudo tras cirugía de la columna lumbar. Un caso clínico / Lumbar erector spinae plane block: Successful control of acute pain after lumbar spine surgery - A clinical report

Divulgamos el caso clínico de una paciente programada para cirugía de la columna lumbar, en la cual realizamos el bloqueo del plano del músculo erector de la columna lumbar como parte de una estrategia analgésica multimodal para el control del dolor agudo. La realización del bloqueo preoperatoriamente descartó la necesidad de opioides intraoperatorios adicionales a los de la intubación y permitió el uso de paracetamol solo para la analgesia. Además, no hubo necesidad de técnicas hipotensivas, ya que el bloqueo proporcionó bloqueo simpático satisfactorio y vasodilatación regional con un campo quirúrgico claro. En el postoperatorio, la paciente tenía un consumo menor de opiáceos y podía moverse libremente sin ningún deterioro motor, ni dolor desde el principio en la Unidad de Cuidados Postanestésicos. El uso del bloqueo del plano del músculo erector de la columna lumbar a nivel lumbar para la analgesia en la cirugía de la columna lumbar enfatiza su amplia aplicación y eficacia analgésica

We report the successful clinical case of a patient scheduled for lumbar spine surgery in which we performed a bilateral single-shot erector spinae plane block as part of a multimodal analgesic strategy for pain control. Performing the block preoperatively dismissed the need for extra intraoperative opioids other than those for intubation, and enabled the use of paracetamol for analgesia only. Further, there was no need for hypotensive techniques, as the block provided satisfactory sympathetic blockade and regional vasodilation with a clear surgical field. Postoperatively, the patient had minor opioid consumption and was able to freely move without any motor impairment or pain from early on in the Post Anaesthesia Care Unit. The use of single-shot erector spinae plane block at the lumbar level for lumbar spine surgery analgesia emphasises its wide application and analgesic efficacy

Lumbar erector spinae plane block: Successful control of acute pain after lumbar spine surgery - A clinical report. / Bloqueo lumbar del plano del músculo erector de la columna: control exitoso del dolor agudo tras cirugía de la columna lumbar. Un caso clínico.

We report the successful clinical case of a patient scheduled for lumbar spine surgery in which we performed a bilateral single-shot erector spinae plane block as part of a multimodal analgesic strategy for pain control. Performing the block preoperatively dismissed the need for extra intraoperative opioids other than those for intubation, and enabled the use of paracetamol for analgesia only. Further, there was no need for hypotensive techniques, as the block provided satisfactory sympathetic blockade and regional vasodilation with a clear surgical field. Postoperatively, the patient had minor opioid consumption and was able to freely move without any motor impairment or pain from early on in the Post Anaesthesia Care Unit. The use of single-shot erector spinae plane block at the lumbar level for lumbar spine surgery analgesia emphasises its wide application and analgesic efficacy.