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Pectoral nerve blocks decrease postoperative pain and opioid use after pacemaker or implantable

Jeffrey K Yang1, Danton S Char2, Kara S Motonaga1

  • 1Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Stanford, California.

Heart Rhythm
|March 24, 2020
PubMed

Insights

Pectoral nerve blocks (PECs) significantly reduced pain and opioid use in children after pacemaker or implantable cardioverter-defibrillator placement. These findings suggest PECs are a valuable tool for pediatric cardiac device procedures.

Area of Science:

  • Pediatric Anesthesiology
  • Cardiology
  • Pain Management

Background:

  • Pectoral nerve blocks (PECs) are known to reduce anesthetic needs and postoperative pain.
  • Limited data exists on the efficacy of PECs for pain and opioid reduction following pacemaker (PM) or implantable cardioverter-defibrillator (ICD) implantation in pediatric patients.

Purpose of the Study:

  • To evaluate the effectiveness of PECs in decreasing postoperative pain and opioid consumption in children undergoing PM or ICD placement.

Main Methods:

  • A retrospective review of pediatric patients who received transvenous PM or ICD implantation between 2015 and 2020.
  • Exclusion criteria included recent cardiothoracic surgery or pre-existing neurologic/developmental deficits.
  • Comparison of pain scores and opioid usage between patients receiving PECs and those receiving conventional local anesthesia (Control group).

Main Results:

  • Patients receiving PECs demonstrated significantly lower pain scores at multiple time points (1, 2, 6, 18, and 24 hours) post-procedure compared to the control group.
  • The mean cumulative pain score was substantially lower in the PECs group (1.5) versus the control group (3.1) (P <.001).
  • Total opioid usage was significantly reduced in the PECs group (6.0 MME/m²) compared to the control group (15.0 MME/m²) (P = .001).

Conclusions:

  • Pectoral nerve blocks effectively reduce postoperative pain and opioid requirements in pediatric patients undergoing pacemaker or ICD implantation.
  • Consideration of PECs during transvenous device placement in children is recommended for improved pain management.
Abstract

Keywords:
ICDOpioidsPacemakerPainPediatrics

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