Optimizing Peri-Operative Pain Management in Children With Long QT Syndrome and Catecholaminergic Polymorphic Ventricular Tachycardia Undergoing Left Cardiac Sympathetic Denervation: A Case Series on Continuous Erector Spinae Plane Block and Serratus Plane Block.

BACKGROUND

Congenital long QT syndrome (LQTS) and Catecholaminergic Polymorphic ventricular Tachycardia (CPVT) are inherited arrhythmogenic disorders leading to an increased risk of life-threatening arrhythmias. Left cardiac sympathetic denervation (LCSD), currently performed by video-assisted thoracoscopic surgery (VATS) is a well-established treatment for patients not fully protected by drugs. Peri-operative pain management represents a challenge.

AIM: To assess the impact of a multimodal approach for perioperative pain management including combined regional anesthesia on postoperative pain scores, opioid requirements and neuropathic pain incidence in pediatric LQTS and CPVT patients undergoing VATS-LCSD.

METHODS

A retrospective analysis was conducted on consecutive children undergoing VATS-LCSD at a single center from 2021 to March 2025. Per protocol, they all received Erector Spinae Plane (ESP) and Serratus Plane (SP) block. A perifascial catheter was placed following ESP for continuous local anesthetic infusion.

RESULTS

15 patients were enrolled (median age 6.9 years, IQR 4.3-9.8, median weight 24 kg, IQR 18.3-35.5). Most (13, 87%) had LQTS and almost one third had a high-risk genotype. There were no major complications. There was only 1 case (7%) of accidental removal of the ESP catheter, in whom prophylactic morphine was used. Pain scores, as assessed by VAS, were below 2 in all patients; none needed additional doses of opioids nor ketorolac or developed neuropathic pain postoperatively.

CONCLUSIONS

Our results support the use of a combined regional anesthesia protocol for peri-operative pain management in pediatric channelopathy patients undergoing VATS-LCSD. This approach may improve overall quality of care for this vulnerable population.