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Erector Spinae Plane (ESP) Block Decreases Narcotic Requirement in Patients Undergoing Subcutaneous ICD Placement Under Sedation
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  • Himani V. Bhatt,
  • Jane Gui,
  • Samit Ghia,
  • Asad Mohammad,
  • Hung-Mo Lin,
  • Yuxia Ouyang,
  • Dane Doctor,
  • Joseph Gallombardo,
  • Joseph Bracker,
  • Davendra Mehta,
  • Ali Shariat
Himani V. Bhatt
Icahn School of Medicine at Mount Sinai Department of Anesthesiology Perioperative and Pain Medicine

Corresponding Author:ranihb@hotmail.com

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Jane Gui
Icahn School of Medicine at Mount Sinai Department of Anesthesiology Perioperative and Pain Medicine
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Samit Ghia
Icahn School of Medicine at Mount Sinai Department of Anesthesiology Perioperative and Pain Medicine
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Asad Mohammad
Icahn School of Medicine at Mount Sinai Division of Cardiology
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Hung-Mo Lin
Yale University Department of Anesthesiology
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Yuxia Ouyang
Icahn School of Medicine at Mount Sinai
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Dane Doctor
Icahn School of Medicine at Mount Sinai Department of Anesthesiology Perioperative and Pain Medicine
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Joseph Gallombardo
Icahn School of Medicine at Mount Sinai Department of Anesthesiology Perioperative and Pain Medicine
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Joseph Bracker
Icahn School of Medicine at Mount Sinai Department of Anesthesiology Perioperative and Pain Medicine
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Davendra Mehta
Icahn School of Medicine at Mount Sinai Division of Cardiology
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Ali Shariat
Icahn School of Medicine at Mount Sinai Department of Anesthesiology Perioperative and Pain Medicine
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Abstract

Introduction: Providing adequate analgesia during subcutaneous ICD implantation can be a challenge. The use of regional techniques such as erector spinae plane (ESP) block can provide both analgesia and attenuate the risk of opioid use especially in high-risk patient populations. Methods: This was a single center, prospective study of patients undergoing SICD implantation from February 2020 to February 2022. Patients were older than 18 years of age and randomly assigned to receive ESP block or traditional wound infiltration. The primary outcome was the overall use of perioperative analgesic medications in the ESP block versus the surgical wound infiltration group. Descriptive data are reported as count, mean, or median, as appropriate. For group comparisons, Fisher’s exact test was used for categorical variables; the student t-test was used for normally distributed continuous variables, and the Krustal-Wallis test was used for skewed continuous variables, as appropriate. Results: 24 patients were enrolled in the study. 11 patients received only wound infiltration and 13 patients received left ESP block. A significant reduction of intraoperative fentanyl use was observed in the ESP block. The overall postoperative day zero fentanyl use was also significantly decreased in the ESP group. The day to discharge was shorter in the ESP block group. Conclusion: This feasibility study showed that ESP block is both a safe and effective technique and demonstrated a significant decrease in intraoperative and postoperative opioid consumption that may be of clinical benefit in high risk patients. Larger studies are needed to further validate its use.