Clavipectoral optimized motor-sparing fascial block for tolerable cardiac implantable electronic device procedures- COMFORT-CIED
Y Yamanturk, O Alkan, E O Ilhan, M E Teker, N Aydinalp, B CandemirAbstract
Background
Cardiac implantable electronic device (CIED) implantation is frequently performed under local infiltration anesthesia; however, discomfort may be significant in elderly, anxious, or conduction-system–pacing candidates. The clavipectoral fascial plane block (CPFB) is a motor-sparing regional block with the potential to improve procedural tolerability without compromising safety.
Aim
To compare CPFB plus local infiltration versus standard local anesthesia alone in terms of procedural pain, safety, and feasibility during CIED implantation.
Methods
In this single-center prospective controlled study (January–November 2025), 59 consecutive patients undergoing CIED implantation were included (Control = 30; CPFB = 29). Allocation reflected patient preference after procedural counselling. Pain was assessed using the Numeric Rating Scale (NRS). Secondary endpoints included methemoglobinemia (MetHb 0/1), MetHb percentage, and distribution of procedures and indications between groups.
Results
A total of 59 patients were included (Control n=30, CPFB n=29). Baseline procedural types and clinical indications were comparable between groups, with no meaningful imbalance (Table 1 and 2). CPFB provided markedly superior analgesia during CIED implantation. The mean NRS score was 5.47 ± 0.94 in the control group compared with 1.22 ± 1.10 in the CPFB group (p < 0.0001, Mann–Whitney U). Methemoglobinemia parameters remained stable and similar between groups. MetHb development occurred in 13% of controls vs 14% of CPFB patients (NS), and mean MetHb levels were 2.95% vs 3.56% respectively (p = NS). No symptomatic MetHb elevation or block-related complications were observed (Table 3).
Conclusion
CPFB combined with local infiltration provides substantially improved analgesia and enhanced patient comfort during CIED implantation, without added risk and with stable MetHb profiles. The technique is motor-sparing, feasible, and especially advantageous in patients undergoing conduction-system pacing or those who are poor candidates for systemic sedation. Larger randomized trials are warranted to confirm these promising results.Table 1 and Table 2Table 3