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Optimizing Peri-Operative Pain Management in Children With Long QT Syndrome and Catecholaminergic Polymorphic

V Mossetti1, R Di Corrado1, H HaxhiNasto1

  • 1Anesthesia and Intensive Care, Regina Margherita Children Hospital, Città Della Salute e Della Scienza, Turin, Italy.

Paediatric Anaesthesia
|November 6, 2025
PubMed

Insights

A multimodal pain management strategy using combined regional anesthesia (Erector Spinae Plane and Serratus Plane blocks) effectively reduced postoperative pain and opioid needs in pediatric patients undergoing VATS-LCSD for long QT syndrome and CPVT.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Pediatric Surgery

Background:

  • Congenital long QT syndrome (LQTS) and Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) are inherited arrhythmogenic disorders increasing arrhythmia risk.
  • Left cardiac sympathetic denervation (LCSD) via video-assisted thoracoscopic surgery (VATS) is a key treatment for drug-refractory cases.
  • Perioperative pain management is a significant challenge in these pediatric patients.

Purpose of the Study:

  • To evaluate a multimodal perioperative pain management approach using combined regional anesthesia.
  • To assess its impact on postoperative pain scores, opioid requirements, and neuropathic pain incidence.
  • Focus on pediatric patients undergoing VATS-LCSD for LQTS and CPVT.

Main Methods:

  • Retrospective analysis of pediatric patients undergoing VATS-LCSD (2021-March 2025).
  • All patients received Erector Spinae Plane (ESP) and Serratus Plane (SP) blocks.
  • Continuous local anesthetic infusion via a perifascial catheter following ESP block.

Main Results:

  • 15 pediatric patients (median age 6.9 years) with LQTS or CPVT were included.
  • No major complications; one accidental ESP catheter removal.
  • All patients reported VAS pain scores below 2, with no additional opioid or ketorolac use and no neuropathic pain.

Conclusions:

  • Combined regional anesthesia (ESP and SP blocks) is effective for perioperative pain management in pediatric channelopathy patients undergoing VATS-LCSD.
  • This multimodal approach may enhance care quality for this vulnerable population.
  • Supports the use of regional anesthesia protocols for improved outcomes.
Abstract

Keywords:
ESP blockcatecholaminergic polymorphic ventricular Tachicardialong QT syndromepediatric regional anesthesiaserratus plane block

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