Pectoral Nerve Block for Cardiac Device Implants: A Systematic Review and Meta-Analysis

Cardiac implantable electronic device (CIED) implants are frequently associated with peri- and post-operative pain. Pectoral nerve block (PECS), initially described for breast surgeries, has increasingly been used in other chest surgeries to alleviate pain, including CIED implants. This systematic review and meta-analysis aimed to estimate the efficacy and safety of the PECS block in pain management of patients undergoing CIED implant.

The Medline (PubMed) and Scopus databases were searched from their inception until May 31, 2025. Randomized controlled trials and observational studies that reported on the PECS block for pain control during CIED implants were included. (PROSPERO CRD420251071794) RESULTS: After exclusion, five eligible studies (n = 816) were included in the meta-analysis. The studies reported low mean pain scores at 1 h, 6 h, and 24 h after CIED implants (1.74±0.65, 0.98±0.12, and 1.06 ± 0.93, respectively). A single study reported statistically lower pain scores with PECS block compared to standard care at four hours (1.5 ± 2.1 vs. 4.5 ± 2.5, p < 0.001). No PECS-related complications were reported in the included studies. PECS was associated with low intra- and post-operative opioid requirement (12.17%, 95% CI 7.7-17.49; I² 5.94% and 9.95%, 95% CI 7.52-12.68; I² 0.00%, respectively).

Available observational evidence suggests that the PECS block is associated with low pain scores, reduced opioid requirements, and high patient satisfaction after CIED implant. However, the evidence remains limited by the lack of robust comparative and randomized data.

CRD420251071794.