Pectoral nerve blocks for transvenous subpectoral pacemaker insertion in children: a randomized controlled study

Abstract

Background: Postoperative pain management after pacemaker insertion routinely uses either opioid agents, nonsteroid anti-inflammatory drugs, or paracetamol. There has been increased interest in opioidsparing multimodal pain management to minimize postoperative narcotic use. This study aims to assess postoperative pain control and opioid consumption provided by pectoral nerve blocks (PECs) versus standard postoperative pain control in pediatric patients after transvenous subpectoral pacemaker insertion.Method: in this randomized controlled study, forty pediatric patients presented for transvenous subpectoral pacemaker insertion, with either congenital or post-operative complete heart block(CHB). :Patients were randomly assigned into two groups according to the method of perioperative pain management, Group C (control) received conventional analgesic care without any block and Group P (pectoral) received PECs. Demographics, procedural variables, postoperative pain, and postoperative opioid usage were compared between the two groups.Results:: Intra-procedure, pectoral nerve blocks reduced cumulative dose of fentanyl and atracurium with better hemodynamic profile and longer procedure time. Post-procedure, pectoral nerve blocks reduced postprocedural pain scores, which was reflected in later first call for rescue analgesia, and lower postoperative morphine consumption, and did not increase rates of complications in children who underwent transvenous subpectoral pacemaker insertion. Conclusion:Ultrasound guided PECs have a good intraoperative hemodynamic profile, reduce postoperative pain scores, and lower total opioid usage in children who underwent transvenous subpectoral pacemaker placement.

PECS II block for cardiac implantable electronic device insertion: A pilot study

“…Only two patients complained of pain in the first 24 h postoperatively. These results are consistent with previous studies that reported PECS II block reduces postoperative pain scores and lower total opioid usage after CIED placement and, demonstrate that PECS II block can be used effectively in the management of postoperative analgesia after CIED insertion 29,30 . Yang et al 29 .…”

“…These results are consistent with previous studies that reported PECS II block reduces postoperative pain scores and lower total opioid usage after CIED placement and, demonstrate that PECS II block can be used effectively in the management of postoperative analgesia after CIED insertion. 29,30 Yang et al 29 reported that PECS II block provided a reduction in both cumulative pain and mean opioid consumption over the 24 h after CIED placement in children. Elhaddad et al 30 also reported that PECS II block not only reduces pain scores and opioid consumption but also provides a good hemodynamic profile in children underwent transvenous subpectoral pacemaker placement.…”

“…29,30 Yang et al 29 reported that PECS II block provided a reduction in both cumulative pain and mean opioid consumption over the 24 h after CIED placement in children. Elhaddad et al 30 also reported that PECS II block not only reduces pain scores and opioid consumption but also provides a good hemodynamic profile in children underwent transvenous subpectoral pacemaker placement.…”