Efficacy of Truncal Plane Blocks in Pediatric Patients Undergoing Subcutaneous Implantable Cardioverter-Defibrillator Placement

Objectives: Pediatric patients undergoing subcutaneous implantable cardioverter-defibrillator (S-ICD) placement usually have substantial postoperative pain. The aim of this study was to investigate the effect of the transversus thoracic muscle plane (TTMP) block combined with serratus anterior plane block (SAPB) in patients undergoing S-ICD placement. Design: A double-blind, randomized controlled study. Setting: First Affiliated Hospital of Nanchang University. Participants: Patients aged nine-to-18 years undergoing S-ICD placement were included. Interventions: A group of 102 patients randomly were allocated to either receive combined nerve blocks (NER group) or no nerve block (CON group). Measurements and Main Results: The primary endpoint was perioperative fentanyl consumption. The secondary outcome measures included pain at rest and after movement at two, four, six, 12, 24, and 48 hours after extubation; 48-hour acetaminophen administration; time to extubation; length of stay in the postanesthesia care unit (PACU); length of hospital stay; codeine tablet consumption; and percentage of patients who had codeine tablets after discharge. The NER group reported significantly less intraoperative (4.1 mg/kg v 3.1 mg/kg, p = 0.04) and postoperative fentanyl consumption (3.8 mg/kg v 1.5 mg/kg, p = 0.006) than the CON group. Compared with the NER group, the CON group had higher Numerical Rating Scale (NRS) pain scores at 24 hours after surgery both at rest and after movement. The time to extubation (20.5 minutes v 12.6 minutes, p = 0.03) and length of stay in the PACU (30.5 minutes v 15.6 minutes, p = 0.02) were significantly decreased in the NER group compared with the CON group. The CON group had a significantly higher postoperative acetaminophen requirement than did the NER group (32 mg/kg v 16 mg/kg, p = 0.01). Conclusion: TTMP block combined with SAPB in pediatric S-ICD placement could provide effective analgesia. (C) 2020 Elsevier Inc. All rights reserved.