Block Technique
A left-sided ESP block at the T 5-6 level was performed under ultrasound guidance (SonoSite SNerve Ultrasound System fitted with an L38 £ 10- to 5-MHz transducer; SonoSite, Inc, Bothell, WA) with a 22 gauge, two-inch stimulating needle (Stimuplex; B. Braun Medical Inc, Bethlehem, PA) using an in-plane technique. A total of 20 mL of 0.25% bupivacaine were deposited between transverse process and erector spinae muscle (Fig 2). For the surgical infiltration group, the proceduralist injected 30 mL of 0.25% bupivacaine into the implantation and tunneling sites before incision. The patients in the ESP group did not receive any additional local anesthetics by the EP team. Patients were administered IV propofol infusion with intermittent boluses of IV midazolam and/or fentanyl as needed.