Study evaluates Innovative Approach to Pain Management in Cardiac Implant Procedures

Recent study aimed to compare the effectiveness of combined PECS 1 block and intercostal nerve block with local infiltration as an analgesic technique during Cardiac Implantable Electronic Device (CIED) implantations. Seventy patients were initially enrolled in the study, with 63 patients scheduled for pacemaker implantations being included. The patient demographics were comparable between the two groups. Pain assessments using the Numeric Rating Scale (NRS) showed significantly higher scores in the local infiltration group during the initial steps of the procedure. However, there were no significant differences in pain scores at 1, 2, 4, 8, and 24 hours post-procedure between the two groups.

Block Approach and Pain Reduction

The study observed that the combined block approach led to a substantial reduction in pain scores and opioid usage during the intraoperative period, along with decreased non-steroidal anti-inflammatory drug (NSAID) requirements in the postoperative period. The PECS 1 block and intercostal nerve block effectively reduced pain levels, with the combined nerve block resulting in lower pain scores during major steps of the procedure. The first demand for analgesia was significantly delayed in patients who received the combined nerve block compared to the local infiltration group.

Combined Block Benefits

Patients who received the combined block required less fentanyl during the procedure and had lower post-procedure paracetamol requirements. The duration of hospital stay and post-procedure pain scores were comparable between both groups. The study highlighted the significance of the PECS 1 block and intercostal nerve block in reducing pain during CIED implantations, emphasizing its potential as an alternative analgesic technique.

Study Methodology

The study method involved randomizing patients into two groups, with Group A receiving local infiltration and Group B receiving the combined PECS 1 block and intercostal nerve block under ultrasound guidance. During the procedure, additional analgesia was provided if NRS scores exceeded 3, and intravenous fentanyl boluses were administered as needed. Pain scores were assessed post-procedure, and IV paracetamol was given if NRS exceeded 3.

Statistical Analysis

Statistical analysis revealed a significant decrease in pain scores at the initial steps with the combined nerve block, a prolonged time for the first analgesia demand, and reduced opioid and paracetamol requirements in the combined block group. The study concluded that the combined PECS 1 and intercostal nerve block provided better analgesia during CIED implantations compared to traditional local infiltration, making it a promising analgesic option for these procedures.

Conclusion

In conclusion, the study demonstrated that the combination of PECS 1 and intercostal nerve block offers improved intraoperative analgesia and lowers the analgesic requirements in patients undergoing CIED implantations. Further research is recommended to validate the efficacy of these newer blocks and explore their potential for enhancing patient comfort and outcomes in similar procedures in the future.

Key Points

- The study compared the efficacy of combined PECS 1 block and intercostal nerve block with local infiltration for analgesia during Cardiac Implantable Electronic Device (CIED) implantations.

- Patients who received the combined block approach had significantly lower pain scores and reduced opioid usage during the procedure compared to those who received local infiltration.

- The combined nerve block approach resulted in delayed demand for analgesia, reduced NSAID requirements postoperatively, and lower pain scores during major procedural steps. - Patients receiving the combined block needed less fentanyl during the procedure and had lower post-procedure paracetamol requirements.

- Statistical analysis showed that the combined PECS 1 and intercostal nerve block led to decreased pain scores, delayed analgesia demand, and reduced opioid and paracetamol requirements compared to local infiltration.

- The study suggests that the combination of PECS 1 and intercostal nerve block provides better analgesia during CIED implantations, highlighting its potential as an alternative analgesic technique for enhancing patient comfort and outcomes.

Reference –

Muhilan Senthilkumar et al. (2025). Comparison Of Combined Pectoralis Plane Block And Intercostal Nerve Block With Local Infiltration Analgesia In Patients Undergoing Cardiac Implantable Electronic Device Implantation - A Randomized Controlled Trial.. *Annals Of Cardiac Anaesthesia*, 28 2, 170-175 . https://doi.org/10.4103/aca.aca_164_24.