الفهرس 
CARDIAC IMPLANTABLE ELECTRONIC DEVICES (CIEDS)Only 14 pages are availabe for public view
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Abstract
T
he use of implantable cardiac electronic devices (CEDs), including pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronized therapy (CRT), is increasing worldwide for the treatment of cardiac arrhythmias. Pain-free life is nowadays considered an essential human right.
Analgesia and sedation are usually challenging during pacemaker implantation. Patients could suffer from severe pain during and following the process.
The ultrasound has further increased the success rate of the blocks, decrease the dosage requirements of the local anesthetics compared to the traditional landmark technique, and allow the visualization of the spread of local anesthetic along the desired fascial planes to anesthetize the target nerves.
The pectoral nerve (PECS) blocks I and II are a novel technique to block the pectoral nerves, intercostal nerves 3 to 6, intercostobrachial nerves and the long thoracic nerve. The PECS II targets the interfacial plane between the pectoralis major muscle and the pectoralis minor muscle as the PECS I but also targets the interfacial plane between the pectoralis minor muscle and the serratus anterior muscle, aiming to block intercostal nerves 3 to 6, intercostobrachial and the long thoracic nerves.
Hence, the aim of this study was to evaluate the effectiveness of PECS I, PECS II blocks as the primary anesthesia technique in patients undergoing subcutaneous pacemaker in comparison to local infiltration anesthesia.
This prospective cohort randomized study was carried out on 40 patients between the ages of 21 to 80 years old undergoing pacemaker implantation in Aswan heart center. Patients were randomly allocated into two equal groups: group (1): received ultrasound guided PECS block using bupivacaine 0.25% and group (2): control group, received standard local infiltration anesthesia with lidocaine 2 % (10-15ml). The primary outcome was 1- The total morphine doses required by the patient in both groups intraoperative and pain scores according to the visual Analog scale (VAS) every 6 hours. The secondary outcomes were patient’s satisfactions were evaluated in both groups, operator’s satisfaction and time of first analgesia required by PCIA once patient start pushing button and total consumption over 24 hours was recorded. group 1 had significantly shorter performance time (36.4± 4.82) than group 2 (42.3±9.08) and postoperative analgesia was significantly lower in group 1 (5%) compared to the group 2 (90 %) (P value <0.001). The hospital stay was significantly lower in PECS blocks group 1(1-2) compared to control group 2 (2-3). Complications was insignificantly different between both groups. Operator and patient satisfaction were significantly better in PECS blocks group compared to control group (P value <0.001).
CONCLUSION
U
ltrasound guided PECs provided adequate analgesia as shown by reducing the times of start procedure and technique, postoperative pain scores and total opioid usage, delayed the time to first require analgesia and better operator and patient satisfaction in pacemaker implantation as compared to infiltration anesthesia.
RECOMMENDATIONS
• Further studies with larger sample size are needed to validate our findings.
• Future studies in different thoracic surgeries are required for ensuring the effectiveness of US-guided PECS blocks.
• US-guided PECS blocks are recommended for pacemaker implantation surgeries.
• Further studies are needed to clarify the relation between dexmedetomidine and pacing time.
LIMITATIONS
• This was a single-center study involving relatively small sample size.
• There were some missing data on pain location.
• Factors connected to the operation (device size and level of surgical trauma).