Wide-awake local anesthesia during insertion of cardiac implantable electronic devices: a randomized study

Introduction:
Wide-awake local anesthesia (WALA) with epinephrine has been demonstrated to be effective in orthopedics and hand surgery, as it offers adequate local anesthesia and obviates the requirement for patient sedation and even the use of a tourniquet to block the blood supply to the proximal extremity.

Aim:
To evaluate the effect of wide-awake local anesthesia on pain and bleeding levels in patients who received cardiac implantable electronic device implantation.

Material and methods:
The patients were randomly assigned to two groups: Group 1, consisting of 21 patients, referred to as the WALA group; and Group 2, consisting of 21 patients, which served as the control group and received local anesthesia. After surgery, the primary operator assigned a bleeding score ranging from 1 to 10 to each patient. The Visual Analog Scale was employed to assess pain.

Results:
The control group had a significantly higher median bleeding score compared to the WALA group (5 vs. 2, p < 0.001). The median intra-procedural and post-procedural pain scores were significantly lower in the WALA group compared to the control group (2 vs. 4, p < 0.001, and 1 vs. 3, p < 0.001, respectively). No surgical revision was necessary for any pocket hematoma.

Conclusions:
WALA anesthesia significantly reduces intra- and post-procedural bleeding and pain. The potential benefits of the technique, such as preventing the formation of pocket hematoma, shortening the duration of the procedure, and accelerating the recovery period, must be demonstrated in randomized trials conducted on a larger number of patients.