Inclusion Criteria:  > 18 years old, Undergoing cardiac device implantation in the suprapectoral area of the chest.  Exclusion Criteria:  Prior neck surgery ipsilateral to the device implantation site Infection over the injection site BMI ≥ 35 Uncooperative patient Patient unable to provide consent Patient has a pre-existing implanted cardiac device in the left chest wall area Device implantation is booked in less than 2 hours.