Feasibility of subcutaneous implantable cardioverter‐defibrillator implantation with opioid sparing truncal plane blocks and deep sedation

• Published in: Journal of cardiovascular electrophysiology Vol. 30; no. 1; pp. 141 - 148
• Main Authors: Miller, Marc A., Garg, Jalaj, Salter, Benjamin, Brouwer, Thomas F., Mittnacht, Alex J., Montgomery, Morgan L., Honikman, Rafael, Arkonac, Derya E., Choudry, Subbarao, Dukkipati, Srinivas R., Reddy, Vivek Y., Weiner, Menachem M.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-01-2019
• Subjects: Adult; Aged; Analgesia; Analgesics; Analgesics, Non-Narcotic - administration & dosage; Analgesics, Non-Narcotic - adverse effects; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Anesthesia; Anesthesia, General - adverse effects; Autonomic Nerve Block - adverse effects; Deep Sedation - adverse effects; Defibrillators, Implantable; Discomfort; Electric Countershock - instrumentation; Feasibility Studies; Female; Humans; Implantation; implantation technique; Male; Middle Aged; Morphine; Narcotics; Opioids; Pain perception; Pain, Postoperative - diagnosis; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Prosthesis Implantation - adverse effects; Prosthesis Implantation - instrumentation; Retrospective Studies; serratus anterior plane block; subcutaneous implantable cardioverter‐defibrillator; sudden cardiac death; Treatment Outcome; serratus anterior plane block; sudden cardiac death; subcutaneous implantable cardioverter-defibrillator; implantation technique; anesthesia
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.13750

Introduction
The subcutaneous implantable cardioverter‐defibrillator (S‐ICD) is most commonly implanted under general anesthesia (GA), due to the intraoperative discomfort associated with tunneling and dissection. Postoperative pain can be substantial and is often managed with opioids. There is a growing interest in transitioning away from the routine use of GA during S‐ICD implantation, while also controlling perioperative discomfort without the use of narcotics. As such, we assessed the feasibility of a multimodal analgesia regimen that included regional anesthesia techniques in patients undergoing S‐ICD implantation.
Methods and Results
Twenty patients received truncal plane block (TBL) immediately before S‐ICD implantation. The first 10 patients were implanted under general anesthesia (GA + TBL), and the next 10 patients were implanted under deep sedation (DS + TBL). Additionally, the DS + TBL patients were also prescribed a structured regimen of nonopioid analgesics in the perioperative period. Opioid consumption was calculated as milligram morphine equivalents (MME). In‐hospital opioid consumption was significantly lower in the patients implanted with DS + TBL (MME = 0) as compared with patients receiving GA + TBL (MME = 60; P = 0.004).
Conclusions
Subcutaneous ICD implantation with anesthesia‐delivered DS and a multimodal anesthetic regimen that includes TBL is feasible and associated with significantly less perioperative opioid consumption.
The subcutaneous implantable cardioverter‐defibrillator (S‐ICD) is most commonly implanted under general anesthesia (GA) due to the intraoperative discomfort associated with tunneling and dissection. Postoperative pain can be substantial, and is often managed with opioids.