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- Title
Controlled sedation with midazolam and analgesia with nalbuphine to alleviate pain in patients undergoing subcutaneous implantable cardioverter defibrillator implantation.
- Authors
Peyrol, Michaël; Barraud, Jérémie; Cautela, Jennifer; Maille, Baptiste; Laine, Marc; Bonello, Laurent; Thuny, Franck; Paganelli, Franck; Franceschi, Frédéric; Koutbi, Linda; Levy, Samuel; Peyrol, Michaël; Barraud, Jérémie; Franceschi, Frédéric
- Abstract
<bold>Purpose: </bold>Subcutaneous implantable cardioverter defibrillator (S-ICD) is an alternative to transvenous ICD to prevent sudden cardiac death. Subcutaneous ICD implantation frequently requires general anesthesia because of procedure nociceptive steps during creation of a large device pocket and lead tunneling. This study aims to determine if a strategy of operator-guided controlled sedation with midazolam and analgesia with nalbuphine is effective in alleviating pain during S-ICD implantation.<bold>Methods: </bold>This prospective study included consecutive patients undergoing S-ICD implantation under controlled sedation with midazolam and combined analgesia with nalbuphine. The Critical-Care Pain Observation Tool (CPOT), a behavioral pain scale, was used for pain assessment during S-ICD placement and the Numeric Rate Scale (NRS) was used for evaluation of pain recollection after patient recovery. CPOT score of 3 or above and NRS score of 4 or above are considered to be associated with significant pain.<bold>Results: </bold>Sixteen patients were included in this study: Ten men (62.5%) and six women with a mean age of 54 ± 11 years. Indication for S-ICD implantation was primary prevention in 11 patients (68.8%). Mean dose of administrated midazolam and nalbuphine was 0.11 ± 0.03 and 0.27 ± 0.05 mg/kg, respectively. Mean CPOT during the whole procedure was 1.4 ± 1.6. No patient presented procedural pain recollection as all 16 patients had NRS score less than 4. No serious adverse event related to sedation occurred during S-ICD implantation.<bold>Conclusions: </bold>This study suggests that operator-guided controlled sedation with midazolam and analgesia with nalbuphine is effective to alleviate procedural pain in patients undergoing S-ICD implantation and may constitute an alternative to general anesthesia.
- Subjects
IMPLANTABLE cardioverter-defibrillators; PAIN management; MIDAZOLAM; ANALGESIA; NALBUPHINE; THERAPEUTICS; THERAPEUTIC use of narcotics; ANALGESICS; LONGITUDINAL method; PAIN measurement; TREATMENT effectiveness
- Publication
Journal of Interventional Cardiac Electrophysiology, 2017, Vol 49, Issue 2, p191
- ISSN
1383-875X
- Publication type
journal article
- DOI
10.1007/s10840-017-0255-5