Ultrasound-guided serratus anterior plane block combined with the two-incision technique for subcutaneous ICD implantation

BackgroundThe standard technique for implanting a subcutaneous implantable cardioverter defibrillator (S-ICD) requires three incisions and the pocket of the device is created in the subcutaneous tissue of the left lateral thoracic wall. However, a two-incision technique may be adopted, in which the cranial parasternal region is avoided and the device is positioned more deeply, completely under the latissimus dorsi muscle. This can also be combined with ultrasound-guided serratus anterior plane block (US-SAPB) for intraoperative anesthesia and perioperative analgesia. We describe our preliminary experience of US-SAPB combined with the two-incision intermuscular technique. MethodsWe performed US-SAPB 40minutes before starting the procedure, while the patient was in the supine position. The devices were implanted under the latissimus dorsi muscle. All patients were followed-up after hospital discharge. ResultsTwelve patients (male 50%, 5316 years, body mass index 23 +/- 4) underwent the S-ICD implantation with the combined technique. The mean procedure duration was 47 +/- 11 minutes. The procedure was successful and a shock energy of 65J was successful in converting the induced ventricular fibrillation in all patients. The US-SAPB was successful in 92% of cases and only one patient required convertion into general anesthesia due to pain during the procedure. In the postoperative period, patients did not report major discomfort and analgesics were not required. During a median follow-up of 12 months, no complications were reported. ConclusionsSerratus anterior plane block combined with the intermuscular and two-incision technique proved to be safe and effective during the S-ICD implantation procedure.