Tumescent local anesthesia versus general anesthesia for subcutaneous implantable cardioverter-defibrillator implantation: A cost-effectiveness analysis

Jorge Romero, Joan Rodriguez-Taveras, Juan Carlos Diaz, Marta Lorente-Ros, Eric D. Braunstein, Isabella Alviz, Michael Parides, Magued W. Haroun, Lauren Papa, Kartikeya Dave, Daniel Rodriguez, Suraj Krishnan, Christian Toquica, Alejandro Velasco, Mohamed Gabr, Andrea Natale, Luigi Di Biase

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: General anesthesia (GA) is the standard anesthetic approach for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation. Nonetheless, GA is expensive and can be associated with adverse events. Tumescent local anesthesia (TLA) has been shown to reduce in-room and procedural times and to decrease post-procedural pain, all of which could result in a reduction in procedure-related costs. Objective: The purpose of this study is to compare the cost-effectiveness of GA and TLA in patients undergoing S-ICD implantation. Methods: The present study is a prospective, nonrandomized, controlled study of patients who underwent S-ICD implantation between 2019 and 2022. Patients were allocated to either the TLA or the GA group. We performed a cost analysis for each intervention. As an effectiveness measure, the 0–10 point Numeric Pain Rating Scale at 1, 12, and 24 hours post-implantation was analyzed and compared between the groups. A score of 0 was considered no pain; 1–5, mild pain; 6–7, moderate pain; and 8–10, severe pain. Cost-effectiveness was calculated using incremental cost-effectiveness ratios. Results: Seventy patients underwent successful S-ICD implantation. The total cost of the electrophysiology laboratory was higher in the GA group than in the TLA group (median ± interquartile range US$55,824 ± US$29,411 vs US$37,222 ± US$24,293; P < .001), with a net saving of $20,821 when compared with GA for each S-ICD implantation. There was a significant decrease in post-procedural pain scores in the TLA group when compared with the GA group (repeated measures analysis of variance, P = .009; median ± interquartile range 0 ± 3 vs 0 ± 5 at 1 hour, P = .058; 3 ± 4 vs 6 ± 8 at 12 hours, P = .030; 0 ± 4 vs 2 ± 6 at 24 hours, P = .040). Conclusion: TLA is a more cost-effective alternative to GA for S-ICD implantation, with both direct and indirect cost reductions. Importantly, these reduced costs are associated with reduced postprocedural pain.

Original languageEnglish (US)
Pages (from-to)522-529
Number of pages8
JournalHeart Rhythm
Issue number4
StatePublished - Apr 2023
Externally publishedYes


  • Cost-effectiveness analysis
  • General anesthesia
  • Postprocedural pain
  • Subcutaneous implantable cardioverter-defibrillator
  • Tumescent local anesthesia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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