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.