Abstract
Effective anesthesia, analgesia, and hemodynamic stability is important to maintain during pacemaker implantation surgery, especially in the elderly population and patients with compromised cardiac function. As a strategy to avoid the need for intravenous (IV) anesthetics, peripheral nerve block techniques may be used in these specific cases. We report a case of successful pacemaker implantation surgery in a patient with severe Aortic Stenosis (AS) and Sick Sinus Syndrome (SSS) using unilateral pectoralis plane block for surgical anesthesia. Since general anesthesia was considered risky, monitored anesthesia care utilizing peripheral nerve block was planned. A single shot left side pectoralis plane block (PECS II) was done under ultrasound guidance injecting a total of 20 mL of 0.5% Ropivacaine with 1% Lidocaine. No sedation was needed. The patient tolerated the procedure with no significant hemodynamic changes. Patient did not require opioids post-operative and was discharged home in stable condition the next day. This case highlights that PECS block can also provide effective surgical anesthesia for relatively long procedures avoiding the risk of complications associated with IV anesthesia in high risk cardiovascular patients. Additionally, these blocks can provide an opioid sparing option for post-operative management in pacemaker implantation surgeries.
Highlights
Regional anesthesia carries less morbidity and mortality in the perioperative period than general anesthesia or Monitored Anesthesia Care (MAC) with sedation in the elderly population and patients with compromised cardiac function
Effective anesthesia and hemodynamic stability are important to maintain during pacemaker implantation surgery
We report a case of successful pacemaker implantation in a patient with Severe Aortic Stenosis (SAS) and Sick Sinus Syndrome (SSS) using unilateral pectoralis plane block I and II for surgical anesthesia and analgesia
Summary
Regional anesthesia carries less morbidity and mortality in the perioperative period than general anesthesia or Monitored Anesthesia Care (MAC) with sedation in the elderly population and patients with compromised cardiac function. We report a case of successful pacemaker implantation in a patient with Severe Aortic Stenosis (SAS) and Sick Sinus Syndrome (SSS) using unilateral pectoralis plane block I and II for surgical anesthesia and analgesia. Relevant anatomy for this regional anesthetic technique and benefits of this anesthetic technique compared to IV anesthesia are reviewed and discussed. There is no consensus on which anesthetic technique is safer for non-cardiac surgery in SAS patients For this reason, PECS block as a relatively simple fascial plane infiltration technique can be used as it is associated with a good safety profile.
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