Use of Pectoral Nerve Blocks for Pacemaker or ICD Placement in Pediatric Patients

Pectoral nerve blocks were found to diminish pain and opioid use following pacemaker (PM) or implantable cardioverter defibrillator (ICD) placement in children, according to study results published in Heart Rhythm.

There is little data available on the use of pectoral nerve blocks for the management of pain after PM or ICD implantation in pediatric populations.

Of the 74 pediatric patients (≤21 years of age) included in the retrospective study, 20 patients (27%) received pectoral nerve blocks (PECS) and 54 received standard analgesic care (73%). Total operating room time, total opioid consumption under anesthesia, and type of device used (PM or ICD) were comparable for the groups receiving PECS vs standard analgesia. The complication rates were comparable for patients who underwent PECS vs standard care (0% and 7%, respectively).

Pain scores were evaluated at 1, 2, 4, 6, 8, 12, 18, and 24 hours after the procedure. Patients who received PECS vs standard care had lower pain scores at 1, 2, 6, 18, and 24 hours post-implant (P <.05 for all). Pain scores at 4, 8, and 12 hours post-implant were also lower in the PECS vs standard care group, but did not reach statistical significance. The mean cumulative pain score over the 24 hours post-implant was lower for the PECS group (1.5; 95% CI, 0.8-2.2) compared with the standard care group (3.1; 95% CI, 2.7-3.5; P <.001).

Total opioid use, measured in total morphine milligram equivalent (MME) per body surface area (BSA in m2), was lower in the PECS group (6.0 MME/m2; 95%, 3.4-8.6) compared with the control group (15.0 MME/m2; 95% CI, 11.8-18.2; P =.001) in the 24 hours following device implantation. 

In both univariate and multivariate models, the PECS procedure was negatively correlated with mean pain score and total opioid consumption (P <.01 for all).

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Study limitations include its retrospective nature, and the fact that the decision to use PECS was not based on predetermined guidelines or criteria, which may have introduced potential selection bias.

“In our cohort, pectoralis nerve blocks reduced postoperative pain scores, lowered total opioid use, and did not increase rates of complications in children undergoing pacemaker or ICD placement,” the study authors concluded. “[Pectoral nerve blocks] should be considered at the time of transvenous PM or ICD placement in children.”


Yang JK, Char DS, Motonaga KS, et al. Pectoral nerve blocks decrease postoperative pain and opioid use after pacemaker or implantable cardioverter-defibrillator placement in children [published online March 19, 2020]. Heart Rhythm. doi:10.1016/j.hrthm.2020.03.009