title: Pectoral nerves (PECS) and intercostal nerve block for cardiac resynchronization therapy device implantation.
abstract: A 71-year-old man was scheduled to undergo cardiac resynchronization therapy device (CRTD) implantation. He was combined with severe chronic heart failure due to ischemic heart disease. NYHA class was 3 to 4 and electrocardiogram showed non-sustained ventricular. Ejection fraction was about 20% revealed by transthoracic echocardiogram. He was also on several anticoagulation medications. We planned to implant the device under the greater pectoral muscle. As general anesthesia was considered risky, monitored anesthesia care utilizing peripheral nerve block and slight sedation was scheduled. Pectoral nerves (PECS) block and intercostal block was performed under ultrasonography with ropivacaine. For sedation during the procedure, continuous infusion of dexmedetomidine without a loading dose was performed. The procedure lasted about 3 hours, but the patient showed no pain or restlessness. Combination of PECS block and intercostal block may provide effective analgesia for CRTD implantation.
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsuki, Osaka, 569-8686 Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fujiwara
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsuki, Osaka, 569-8686 Japan.
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Komasawa
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsuki, Osaka, 569-8686 Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Minami
keywords: Cardiac resynchronization therapy device implantation; Intercostal nerve block; Pectoral nerves (PECS) block