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.

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