Ultrasound-guided peripheral regional anesthesia vs local infiltration anesthesia for cardiac device implantation: A...

Conventional local infiltration anesthesia (LIA) may not consistently provide adequate analgesia during cardiac device implantation.

This study aimed to compare the analgesic efficacy of ultrasound-guided peripheral regional anesthesia (PRA) with LIA during cardiac device implantation.

We conducted a single-center prospective observational cohort study including patients undergoing first-time cardiac device implantation. Data were collected in real time during routine clinical care. Patients received PRA or LIA according to routine clinical practice, as determined by the treating clinicians. Propensity score matching was performed to reduce selection bias, resulting in 48 matched patients per group. Pain intensity was assessed using a Numerical Rating Scale at predefined intraoperative procedural steps and postoperative time points, as part of standardized periprocedural care. Additional anesthetic supplementation, pain-related movement, and adverse events were recorded.

Among the matched patients (n = 96), pain scores at all 7 procedural steps were significantly lower in the PRA group than in the LIA group (all P < .01). In the LIA group, pain intensity peaked during pocket creation (all P < .05), whereas pain scores remained relatively consistent across procedural steps in the PRA group. Postoperative Numerical Rating Scale scores at 2-24 hours were significantly lower in the PRA group (all P < .05). Pain-related movement and additional anesthetic supplementation were less frequent in the PRA group. Adverse events were infrequent and comparable between groups.

In this propensity score-matched prospective observational cohort study, ultrasound-guided PRA was associated with improved periprocedural analgesia without an observed increase in adverse events.