regional anesthesia | Acta Medica Marisiensis

Technique presentation: The combination of Pectoralis and Serratus Plane Nerve Blocks for cardiac implantable devices

Mihaela Butiulca^1,2, Lenard Farczadi³, Alexandra Lazar^1,2

1. Department of Anesthesiology and Intensive Care Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Anesthesiology and Intensive Care Medicine, Emergency County Hospital, Târgu Mureș, Romania
3. Chromatography and Mass Spectrometry Laboratory, Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2024-0038

Cardiac resynchronization therapy devices, implantable cardioverter defibrillators, and pacemakers are used to treat advanced systolic heart failure, ventricular tachyarrhythmias, and bradyarrhythmia. Over the past ten years, there has been a notable rise in the number of cardiac implanted electronic device implants because of mounting evidence of better survival and quality of life among specific patient populations. Appropriate analgesia and sedation throughout the implantation procedure is crucial for the patient’s stability. This paper aims to describe the advantages of both interpectoral plane block (PECS I) and interpecto-seratus plane block (PECS II) for the implantation of cardiac devices.
Combining PECS I and PECS II blocks provides advantages for the thoracic wall procedures. While the PECS I block anesthetizes the medial and lateral pectoral nerves, PECS II extends coverage to upper intercostal nerves (T2-T7), as well as the long thoracic and thoracodorsal nerves, covering areas that are not anesthetize adequately by PECS I alone. Minimizing the need for opioids, leading to fewer opioid related side effects contributing to shorter recovery time and nonetheless creating less discomfort for the patient.
This combined regional technique offers comfort to the patient due to its sole puncture needed for performance and by offering an extensive anesthesia at the site of the procedure.

Objective: The aim of this study was to evaluate the clinical utility of Ropivacaine 0.5% and Lidocaine 0.5% anestethic combination in performing locoregional anesthesia, using either peripheral nerve stimulator or ultrasounds for brachial plexus block.
Study design: A prospective randomized clinical study was performed at the County Emergency Clinical Hospital of Tîrgu Mureș, between January and May 2013 on patients undergoing elective or emergency surgical interventions on upper limbs with locoregional anesthesia. Brachial plexus block with axillary approach was performed in 65 patients using randomly the nerve stimulator or the ultrasound guided technique. The parameters recorded were the duration of the anesthetic technique, the installation time and the length of anesthesia. All anesthetic incidents during and after anesthesia were observed as well. The recorded data were analyzed and statistically processed.
Results: We enrolled 40 (61.5%) patients for the nerve stimulation technique and 25 (38.5%) patients for ultrasound guidance. The quality of the block was acceptable, an inadequate anesthesia was reported in 9 patients (13.8%). The mean time of installation of anesthesia was 34.36 (± 11.56) minutes, time recorded from the initiation of the anesthetic technique until complete motor block. The mean duration of the motor block was 481.3 (± 128.6) minutes which represents over 8 hours. None of the patients required conversion of the anesthesia due to the extended period of the surgical intervention. One patient presented a mild allergic reaction to the anesthetic drugs.
Conclusion: Combination of the ropivacaine and lidocaine can be safely used for locoregional anesthesia, especially in those cases where long surgical intervention time is anticipated or in order to achieve a better postoperative analgesia.