Pectoralis blocks for insertion of an implantable cardioverter defibrillator in two patients with Duchenne muscular dystrophy

Alexander B Froyshteter, Tarun Bhalla, Joseph D Tobias, Gregory S Cambier, Christopher T Mckee, Alexander B Froyshteter, Tarun Bhalla, Joseph D Tobias, Gregory S Cambier, Christopher T Mckee

Abstract

Patients with Duchenne muscular dystrophy (DMD) often have systemic manifestations with comorbid involvement of the cardiac and respiratory systems that increase the risk of anesthetic and perioperative morbidity. These patients frequently develop progressive myocardial involvement with cardiomyopathy, depressed cardiac function, and arrhythmias. The latter may necessitate the placement of an automatic implantable cardioverter defibrillator (AICD) insertion. As a means of avoiding the need for general anesthesia and its inherent potential of morbidity, regional anesthesia may be used in specific cases. We present two cases of successful AICD insertion in patients with DMD using unilateral pectoralis and intercostal nerve blocks supplemented with intravenous sedation. Relevant anatomy for this regional anesthetic technique is reviewed and benefits of this anesthetic technique compared to general anesthesia are discussed.

Keywords: Duchenne muscular dystrophy; Pectoralis block; regional anesthesia.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Ultrasound image showing the needle path for the pectolaris blocks (a). The relevant anatomical structures are labeled (b)
Figure 2
Figure 2
Ultrasound probe placement for the pectolaris blocks, with cephalad on the left and caudad on the right. Needle insertion is in-plane with the ultrasound probe

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Source: PubMed

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