Pectoralis Plane Block for Pacemaker Insertion: A Successful Primary Anesthetic

Area of Science:

• Anesthesiology
• Cardiology
• Regional Anesthesia

Background:

• Maintaining hemodynamic stability during pacemaker implantation is crucial, particularly in elderly patients or those with compromised cardiac function.
• Intravenous (IV) anesthetics pose risks for high-risk cardiovascular patients, necessitating alternative anesthesia strategies.
• Peripheral nerve blocks present a viable option for avoiding general or IV anesthesia in these specific surgical cases.

Observation:

• A case report details successful pacemaker implantation surgery in a patient with severe Aortic Stenosis (AS) and Sick Sinus Syndrome (SSS).
• Unilateral pectoralis plane block (PECS II) under ultrasound guidance was employed for surgical anesthesia, avoiding general anesthesia.
• The procedure was performed using a single-shot block with 0.5% Ropivacaine and 1% Lidocaine, without the need for sedation.

Findings:

• The patient tolerated the pacemaker implantation surgery well, with no significant hemodynamic changes observed.
• No post-operative opioids were required, and the patient was discharged the following day in stable condition.
• The pectoralis plane block provided effective surgical anesthesia for the procedure.

Implications:

• Pectoralis plane (PECS) block can serve as a safe and effective anesthetic technique for pacemaker implantation in high-risk cardiovascular patients.
• This approach mitigates the risks associated with IV anesthesia in this population.
• PECS block facilitates an opioid-sparing strategy for post-operative pain management, enhancing recovery after pacemaker surgery.