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Pectoral nerve blocks for transvenous subpectoral pacemaker insertion in children: a randomized controlled study
Ahmed Mohamed Elhaddad1, Salwa Mohamed Hefnawy1, Mohamed Abd El-Aziz2
1Department of Anesthesia, Kasr Alainy, Cairo University/Abo Elreesh Children's Hospital, Cairo, Egypt.
Insights
The pectoral nerve (PECS) block effectively reduces postoperative pain and opioid use in pediatric patients after pacemaker insertion. This opioid-sparing technique offers a superior hemodynamic profile and improved pain control compared to standard care.
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.
Background:
Postoperative pain management after pacemaker insertion routinely requires opioid agents, nonsteroidal anti-inflammatory drugs, or paracetamol. However, interest in opioid-sparing multimodal pain management to minimize postoperative narcotic use has increased recently. This study aimed to assess the pectoral nerve (PECS) block versus standard treatment on postoperative pain control and opioid consumption in pediatric patients after transvenous subpectoral pacemaker insertion.
Methods:
In this randomized controlled study, 40 pediatric patients underwent transvenous subpectoral pacemaker insertion with either congenital or postoperative complete heart block. Patients were randomly assigned to two groups: Group C (control) received conventional analgesic care without any block and Group P (pectoral) received a PECS block. Demographics, procedural variables, postoperative pain, and postoperative opioid consumption were compared between the two groups.
Results:
In children undergoing transvenous subpectoral pacemaker insertion, the PECS block was associated with a longer procedure time; however, the cumulative dose of fentanyl and atracurium was reduced and the hemodynamic profile was superior in Group P compared with Group C intraoperatively. Postoperatively, the PECS block was associated with lower postprocedural pain scores, which was reflected by the longer interval before the first call for rescue analgesia and lower postoperative morphine consumption, without an increase in the rate of complications.
Conclusion:
Ultrasound-guided PECS blocks are associated with a good intraoperative hemodynamic profile, reduced postoperative pain scores, and lower total opioid consumption in children undergoing transvenous subpectoral pacemaker placement.
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