P524Serratus anterior plane block in subcutaneous implantable cardioverter defibrillator implantation: a case-control analysis

Funding Acknowledgements

No Funding

OnBehalf

RHYTHM DETECT study group

Background

A two-incision technique, in association with inter-muscular positioning of the subcutaneous defibrillator (S-ICD), is now the most frequently adopted implantation approach in Europe. Ultrasound-guided serratus anterior plane block (SAPB) has been proposed in order to provide anesthesia/analgesia during S-ICD implantation.

Objective

We performed a case-control analysis in which a standardized SAPB approach was compared with the typical local anesthesia and sedation approach.

Methods

91 consecutive patients underwent implantation of an S-ICD with the SAPB approach for anesthesia/analgesia at 10 centers. The control group consisted of 55 consecutive patients who underwent S-ICD implantation with standard local approach.

Results

The mean procedure duration was 59 ± 15min in the SAPB group and 76 ± 23min in the control group (p < 0.001). No operative complications were reported in either group. During the procedure, 79 (87%) patients in the SAPB group and 25 (46%) patients in the control group (p < 0.001) remained awake. Lower values of pain intensity at the device pocket (p = 0.005) and the lateral tunneling site (p = 0.046) were reported in the SAPB group. The difference in static (p = 0.002) and dynamic (p = 0.007) pain intensity between the groups persisted at 1 hour, while no differences were observed 6 hours after the end of the procedure.

Conclusions

SAPB is feasible and effective in providing anesthesia/analgesia during S-ICD implantation. The procedures were successfully accomplished and no complications occurred in either group. However, SAPB was associated with lower pain levels, enabling the need for sedation to be reduced and more patients to remain awake. Moreover, it resulted in shorter procedure durations.

An unusual cause of cardiogenic shock: tricuspid regurgitation and right ventricular perforation due to vena cava filter migration

Dislocation and migration of the inferior vena cava filter to the right heart is an uncommon but serious complication, requiring prompt diagnosis and appropriate therapy. We report the case of a seventy-year old man, who had previously undergone vena cava filter implantation and who was admitted to the Intensive Care Unit due to acute respiratory distress with the suspect of pneumonia-related sepsis. Due to the worsening of hemodynamics and the development of cardiogenic shock, the patient underwent bedside echocardiography, which on the contrary revealed dislocation of the filter and the entrapment of the device within the tricuspid valve and chordae tendineae. This evidence was confirmed also by the chest-abdominal X-ray. The patient underwent tricuspid valve surgical replacement and successfully recovered. The transthoracic and transesophageal echocardiographies performed in the intensive care unit were able to first orient the diagnostic efforts toward the correct cause.