Pectoral nerve blocks decrease postoperative pain and opioid use after pacemaker or implantable cardioverter–defibrillator placement in children

Yang, Jeffrey; Char, Danton; Motonaga, Kara S.; Navaratnam, Manchula; Dubin, Anne M.; Trela, Anthony; Hanisch, Debra; McFadyen, Grant; Chubb, Henry; Goodyer, William R.; Ceresnak, Scott R.

doi:10.1016/j.hrthm.2020.03.009

Cited by 22 publications

(22 citation statements)

References 19 publications

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“…All device implants in pediatric patients are done under general anesthesia, and many of these patients have high-risk cardiorespiratory comorbidities that make general anesthesia more dangerous. [10] .…”

Section: Discussionmentioning

confidence: 99%

“…A 22 G needle was advanced from anteromedial to posterolateral using an in-plane technique until the fascial plane was reached, and 0.25 ml/kg of 0.25% of bupivacaine was deposited between the pectoralis major and minor muscles (PECs I). The probe was then moved laterally to identify the 4th rib then the needle advanced to deposit another 0.25 ml/kg of 0.25% of bupivacaine between pectoralis minor and serratus anterior (PECs II) [10] . (Fig.…”

Section: Patient Positioning and Preparation For The Blockmentioning

confidence: 99%

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

Elhaddad

Hefnawy

Elaziz

et al. 2023

Korean J Anesthesiol

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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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Section: Discussionmentioning

confidence: 99%

Section: Patient Positioning and Preparation For The Blockmentioning

confidence: 99%

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

Elhaddad

Hefnawy

Elaziz

et al. 2023

Korean J Anesthesiol

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“…Currently, locoregional anesthesia techniques are very diffused, especially in major surgery such as colorectal and liver surgery, thoracic surgery, orthopedic surgery and kidney transplant surgery. The utility of PECS II and serratus plane block is widely demonstrated in other surgeries such as mastectomy [ 15 ], thoracic surgery [ 16 ], pacemaker implantation [ 17 ], traumatology for ribs fracture [ 18 ] and pediatric surgery [ 19 ], but there are not many studies in cardiac adult surgery. Ultrasound-guided fascial plane blocks have been embraced enthusiastically as an alternative to epidural, paravertebral and perineural injections [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided PECS II + Serratus Plane Fascial Blocks Are Associated with Reduced Opioid Consumption and Lengths of Stay for Minimally Invasive Cardiac Surgery: An Observational Retrospective Study

Torre

Pirri

Contristano³

et al. 2022

Life

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This study tested the hypothesis that pectoralis II (PECS II) + serratus plane blocks would reduce opioid consumption and improve outcomes compared with standard practice in minimally invasive cardiac surgery. A retrospective and observational study was realized in the intensive care unit (ICU) setting of “ICLAS GVM, Istitituto Clinico Ligure Alta Specialità, (Rapallo, Italy)”, including adult patients who underwent right minithoracotomy for replacement/plastic aortic, mitral and tricuspid valve or atrial myxoma resection in cardiac surgery. Seventy-eight patients were extracted by the database and divided into two groups. Group 1 (41 patients) received ultrasound-guided PECS II + serratus plane blocks with Ropivacaine 0.25% 10 mL + 20 mL + 30 mL. Group 2 (37 patients) received intravenous opioids analgesia with morphine 20–25 mg/day or tramadol 200–300 mg/day. The primary outcomes were: the pain perceived: Critical-Care Pain Observation Tool (CPOT) score; the opioids consumption: mg morphine or tramadol, or µg sufentanyl administered; and mg paracetamol, toradol, tramadol or morphine administered as a rescue. The secondary outcomes were the hours of orotracheal intubation and of stay in ICU, and the number of episodes of nausea, vomiting, delayed awakening and respiratory depression. Group 1 vs. Group 2 consumed less opioids (Sufentanyl p < 0.0001; Morphine p < 0.0001), had a lower pain perceived (p = 0.002 at 6 h, p = 0.0088 at 12 h, p < 0.0001 at 24 h), need for rescue analgesia (p = 0.0005), episodes of nausea and vomiting (p = 0.0237) and intubation time and ICU stay (p = 0.0147 time of IOT, p < 0.0001 stay in ICU). Ultrasound-guided PECS II + serratus plane blocks demonstrated better than intravenous opioids analgesia in patients undergoing minimally invasive cardiac surgery.

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“…However, some patients are poor candidates for intravenous sedation, such as those who have not fasted, had documented anesthetic intolerance/reactions, are hemodynamically unstable or elderly, and those with neuromuscular diseases. 3 , 4 Nerve blocks have been previously reported to control postoperative pain in patients undergoing cardiac device implantation 5 , 6 , 7 ; however, pain control during the implantation procedure has always required intravenous sedation and local anesthetic administration. Here, we introduce a novel combination of the SCN and PECS 1 blocks, which are easy to learn, safe to perform, and provide highly effective anesthetic for patients during and after CIED implantation.…”

Section: Discussionmentioning

confidence: 99%

A Novel Nerve Block Technique for a Patient Undergoing Cardiac Device Implantation

et al. 2022

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Pectoral nerve blocks decrease postoperative pain and opioid use after pacemaker or implantable cardioverter–defibrillator placement in children

Cited by 22 publications

References 19 publications

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

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

Ultrasound-Guided PECS II + Serratus Plane Fascial Blocks Are Associated with Reduced Opioid Consumption and Lengths of Stay for Minimally Invasive Cardiac Surgery: An Observational Retrospective Study

A Novel Nerve Block Technique for a Patient Undergoing Cardiac Device Implantation

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