Heart rhythm | 2021
Tumescent Local Anesthesia Versus General Anesthesia for Subcutaneous Implantable Cardioverter-Defibrillator Implantation.
Abstract
BACKGROUND\nSubcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective alternative to the transvenous ICD (T-ICD). General anesthesia (GA) is considered the standard sedation approach due to the pain caused by the manipulation of subcutaneous tissue with S-ICD implantation. However, GA carries several limitations, including additional risk for adverse events, prolonged in-room times, and increased costs.\n\n\nOBJECTIVE\nDefine the effectiveness and safety of tumescent local anesthesia (TLA) in comparison to GA in patients undergoing S-ICD implantation.\n\n\nMETHODS\nWe performed a prospective non-randomized controlled multi-center study of patients referred for S-ICD implantation between 2019 and 2020. Patients were allocated to either TLA or GA based on patient s preferences and/or anesthesia service availability. TLA was prepared using lidocaine, epinephrine, sodium bicarbonate, and sodium chloride. All patients provided written informed consent, and the institutional review board at each site provided approval for the study.\n\n\nRESULTS\n60 patients underwent successful S-ICD implantation from July 2019 to November 2020. 30 patients (50%) received TLA and the rest GA. There were no differences between groups regarding baseline characteristics. In-room and procedural times were significantly shorter with TLA (107.6 vs. 186 min; p value <0.0001 and 53.2 vs 153.7 min; p<0.0001, respectively). Pain was reported less frequently by TLA patients. The use of opioids was significantly reduced in TLA patients (23% vs 62%, p=0.002).\n\n\nCONCLUSION\nTLA is an effective and safe alternative to GA in S-ICD implantation. Use of TLA is associated with shorter in-room and procedural times, less post-procedural pain, and reduced usage of opioids for analgesia.