Pectoral nerve blocks for transvenous subpectoral pacemaker insertion in children: a randomized controlled study

Area of Science:

• Anesthesiology
• Pediatric Cardiology
• Pain Management

Background:

• Postoperative pain management after pacemaker insertion often relies on opioids.
• There's a growing interest in opioid-sparing multimodal pain strategies.
• Minimizing postoperative narcotic use is a key goal in pediatric care.

Purpose of the Study:

• To evaluate the effectiveness of the pectoral nerve (PECS) block compared to standard treatment for postoperative pain control.
• To assess opioid consumption in pediatric patients following transvenous subpectoral pacemaker insertion.
• To compare pain management outcomes between PECS block and conventional analgesia.

Main Methods:

• A randomized controlled study involving 40 pediatric patients undergoing transvenous subpectoral pacemaker insertion.
• Patients were divided into two groups: control (conventional analgesia) and pectoral (PECS block).
• Demographics, procedural variables, pain scores, and opioid consumption were compared.

Main Results:

• The PECS block group showed reduced intraoperative fentanyl and atracurium doses and a superior hemodynamic profile.
• Postoperatively, the PECS block group experienced lower pain scores and reduced morphine consumption.
• The interval to first rescue analgesia was longer in the PECS block group, with no increase in complications.

Conclusions:

• Ultrasound-guided PECS blocks improve intraoperative hemodynamics in pediatric pacemaker patients.
• PECS blocks significantly reduce postoperative pain scores and opioid requirements.
• This technique offers a safe and effective opioid-sparing approach for pain management after pacemaker placement.