Clavipectoral Fascial Plane Block for Analgesia in Cardiac Implantable Electronic Device Implantation

This study aimed to evaluate the intraoperative and postoperative analgesic effectiveness of ultrasound-guided clavipectoral fascial plane block in patients undergoing cardiac implantable electronic device (CIED) implantation.

In this prospective observational study, 35 adult patients scheduled for CIED implantation received an ultrasound-guided clavipectoral fascial plane block. Intraoperative analgesic adequacy was assessed by the requirement for supplemental local anesthetic. Additional intraoperative fentanyl use, block performance time, and surgical duration were recorded. Postoperative pain was evaluated using the numerical rating scale (NRS) at 1, 6, 12, and 24 h. Postoperative analgesic consumption and patient satisfaction, assessed using a 5-point Likert scale, were also documented.

Supplemental local anesthetic was required in 16 patients (45.7%), while 19 patients (54.3%) completed the procedure without additional local anesthetic. Among patients requiring supplementation, the median volume of local anesthetic administered was 6 mL (IQR 6-10). Intraoperative fentanyl was administered in seven patients (20.0%). Median block performance time was 6 min (IQR 5-8), and median surgical duration was 39 min (IQR 33-43). Postoperative pain scores remained low over 24 h. Rescue tramadol was required in 11 patients (31.4%), with a median consumption of 0 mg (IQR 0-50). Patient satisfaction was high, with 71.4% of patients reporting satisfaction or high satisfaction.

Clavipectoral fascial plane block appears to provide clinically relevant intraoperative and postoperative analgesia in patients undergoing CIED implantation, with low opioid requirements and high patient satisfaction. This technique may represent a practical component of multimodal analgesia for CIED procedures. Further randomized studies are needed to confirm these findings.