Intraoperative pectoral nerve blocks during cardiac implantable electronic device procedures

Area of Science:

• Electrophysiology
• Pain Management
• Regional Anesthesia

Background:

• Cardiac implantable electronic device (CIED) procedures are associated with significant postoperative pain.
• Opioid use for pain management carries risks, including persistent use.
• Pectoral nerve (PECs) blocks show promise for chest wall pain but are underutilized in electrophysiology.

Purpose of the Study:

• To assess the effectiveness of intraoperative ultrasound-guided PECs blocks during CIED procedures.
• To evaluate if blocks performed by the implanting physician from the device pocket are beneficial.

Main Methods:

• A prospective study included 610 patients undergoing CIED procedures across 7 centers (2022-2023).
• Patients received either intraoperative PECs blocks plus local anesthetic or local anesthetic alone.
• Postoperative pain was prospectively evaluated.

Main Results:

• PECs blocks reduced pain scores within 4 hours post-procedure (1.5 vs 4.5).
• Patients receiving PECs blocks were less likely to require inpatient opioids (10% vs 48%) or receive an opioid prescription at discharge (15% vs 59%).
• PECs block, age, and absence of chronic pain were linked to lower acute pain.

Conclusions:

• Intraoperative PECs blocks effectively decrease postoperative pain and opioid consumption after CIED procedures.
• The technique is feasible for implanting physicians to perform within the device pocket during the procedure.