Comparison between general anesthesia and superficial cervical plexus block in partial thyroidectomies

A comparative evaluation of landmark versus modified technique of superficial cervical plexus nerve block in the maxillofacial surgical practice

PURPOSE

This study aims to compare two techniques for administering superficial cervical plexus block (SCPB) in maxillofacial surgery: the landmark technique and the modified technique proposed by Hadzic. The research explores whether the modified technique improves precision, accelerates anesthetic onset, and enhances patient outcomes.

METHODS

A prospective, single-blinded, randomized clinical study was conducted on 35 patients undergoing maxillofacial surgical procedures at the Goa Dental College and Hospital. Patients were divided into two groups: Group A received SCPB using the landmark technique, and Group B received the modified technique. Both groups underwent additional inferior alveolar and buccal nerve blocks. Key variables measured included time to anesthetic onset, pain levels using the visual analogue scale (VAS), patient comfort, and intraoperative anesthetic requirements. Data were analyzed using SPSS version 22, employing the Mann-Whitney U test and Wilcoxon signed-rank test.

RESULTS

The modified technique demonstrated a significantly shorter mean onset time of anesthesia (4.66 ± 1.27 min) compared to the landmark method (11.72 ± 3.78 min; p < 0.001). Postoperative pain scores after 10 min were significantly lower in the modified group (p < 0.001). Both groups reported high patient comfort, with minimal complications observed.

CONCLUSION

In conclusion, the superficial cervical plexus block is safe and effective for oral and maxillofacial surgeries, providing good anesthesia for the jaw and neck. While generally sufficient, deeper anesthesia may be required for some procedures. Combined with a mandibular nerve block, it offers a reliable alternative to general anesthesia. However, a larger, more diverse sample is needed to evaluate its efficacy across procedures.

CLINICAL TRIAL NUMBER

Not applicable.

Local and Loco-Regional Anesthesia in Patients Who Underwent Thyroid and Parathyroid Surgery

Background/Objectives: Globally, thyroid and parathyroid diseases are common and often require surgery. This review evaluates the current literature on the use of regional anesthesia in these surgeries, highlighting its advantages, limitations, and areas requiring further research. Methods: MEDLINE (via PubMed) and ResearchGate, the largest academic social networks, were utilized to retrieve literature on the topic. Results: Fifteen studies with few patients and largely uncontrolled on the use of loco-regional anesthesia (LRA) not combined with general anesthesia (GA) were found. Meanwhile, twenty-two better quality studies involving several patients on LRA combined GA were found. Conclusions: LRA, in combination with GA, has been proven to be the most reliable evidence for reducing opioid use and postoperative nausea and vomiting. LRA, not combined with GA, has been used in a few well-conducted studies; it seems to be feasible to use even in patients with severe systemic disease. Future controlled studies will need to validate its effectiveness and safety.

Thyroidectomy under local versus general anesthesia in health camp settings in Uganda: a randomized prospective equivalence single-blind controlled trial

BACKGROUND

Endemic goiter is highly prevalent in Uganda, placing a considerable surgical burden on the healthcare system. Across Africa, prevalence varies widely, reaching 60.2%, with visible goiter affecting 30% of Uganda's rural population despite salt iodization programs. Despite evidence supporting thyroidectomy under local anesthesia (LA) for selected cases, its importance is underestimated moreover with limited access to general anesthesia (GA) and critical care providers in resource-constrained settings. The trial compared outcomes of thyroidectomy under LA versus GA in grade 1-2 uncomplicated euthyroid goiter patients in Uganda, with an aim to assess feasibility of LA as an alternative technique.

METHODS

In this prospective equivalence randomized, single-blind controlled trial, participants with grade 1-2 uncomplicated euthyroid goiters were enrolled and randomly assigned to two arms (LA and GA) during surgical camps in Uganda. The study compared early postoperative outcomes, including nausea, vomiting, hematoma formation, transient voice changes, and pain at 6, 12, and 24 h. It also assessed overall incurred material and medication costs, patient satisfaction using a 5-point Likert scale, and willingness to undergo a similar procedure with the same anesthetic technique at 30 days.

RESULTS

Fifty-eight participants undergoing thyroidectomy received random assignment, twenty-nine for each arm. No significant differences were found between the 2 groups in demographics, symptom duration, and early post-operative complications or patients' level of satisfaction (P > 0.05). However, the overall material and medication costs were significantly lower in the LA Group (P < 0.001).

CONCLUSIONS

Thyroidectomy under LA can be performed in a well-selected patient population with low complication rates and comparable patient satisfaction to GA. These findings may support LA for thyroidectomy as a valuable cost-efficient alternative, especially in low-resource settings with fewer GA providers.

TRIAL REGISTRATION

First registered on 31/07/2022, PACTR202208635457430 by Pan African Clinical Trial Registry.

Improving Operating Room Efficiency in Otolaryngology-Head and Neck Surgery: A Scoping Review

OBJECTIVE

One minute of operating room (OR) time costs $36 to 37. However, ORs are notoriously inefficient. There is growing literature on improving OR efficiency, but no formal review of this topic within otolaryngology has been performed. This study reviews and synthesizes the current literature on improving OR efficiency within otolaryngology.

DATA SOURCES

MEDLINE, EMBASE, Web of Science, CINAHL, Cochrane Library, preprints.org, and medRxiv were searched on November 4, 2022.

REVIEW METHODS

Published English studies were included if they reported on metrics for improving OR efficiency within otolaryngology. There were no publication date restrictions. Articles were screened by 2 reviewers. Preferred Reporting Items for Systematic Reviews and Meta-analysis reporting for scoping reviews was followed.

RESULTS

The search yielded 9316 no-duplicate articles; 129 articles were included. Most of the studies reported on head and neck procedures (n = 52/129). The main tactics included surgical considerations: hemostatic devices, techniques, and team/simultaneous approaches; anesthetic considerations: local anesthetic and laryngeal mask airways; procedure location considerations: procedures outside of the OR and remote technologies; standardization: equipment, checklists, and personnel; scheduling considerations: use of machine learning for booking, considering patient/surgeon factors, and utilizing dedicated OR time/multidisciplinary teams for on-call cases.

CONCLUSION

The current literature brings to attention numerous strategies for improving OR efficiency within otolaryngology. Applying these strategies and implementing novel techniques to manage surgical cases may assist in offloading overloaded health care systems and improving access to care while facilitating patient safety and outcomes. Anticipated barriers to implementation include resistance to change, funding, and the current strain on health care systems and providers.

Euthyroidectomy under local versus general anesthesia in health camp settings in Uganda: a protocol for randomized prospective equivalence single-blind controlled trial

BACKGROUND

Endemic goiter is highly prevalent in Uganda at 60.2%, contributing to the high surgical burden. While compelling evidence suggest that in selected cases, thyroidectomy under local anesthesia (LA) is associated with fewer post-operative complications, low costs, and short hospital stays, local anesthesia is not considered a priority technique for thyroidectomy in resource-constrained settings such as Uganda, despite having fewer general anesthesia (GA) and critical care providers. The objective of this trial is to compare euthyroidectomy under local versus general anesthesia among patients with grade 1-2 uncomplicated euthyroid goiter in Uganda.

METHODS

This prospective equivalence randomized, single-blind controlled trial protocol will be conducted among eligible participants with grade 1-2 uncomplicated euthyroid goiters. The recruitment processes will start in October 2022 and end in April 2023. Consenting participants with an indication for thyroidectomy will be randomized into two arms of 29 participants in each arm during the Bulamu Health Care Organization surgical camps in Uganda.

DISCUSSION

The primary outcome of this trial protocol is to compare the early post-operative complications of euthyroidectomy done under LA versus GA. The outcome variables include post-operative pain based on visual analogue scale, nausea, vomiting, hematoma formation, and transient voice changes determined at an interval of 6, 12, and 24 h and at 30 days. In addition, we shall compare the surgical site infection rates, procedure costs, hospital stay, and patients' level of satisfaction based on a 5-point Likert scale and their willingness to undergo a similar surgery using the same anesthetic technique between the two groups. We hypothesize that euthyroidectomy under LA could potentially offer similar benefits as GA, reduce costs related to procedure, complications, and hospital stay while at the same time mitigating the unmet need for surgery attributable to shortage of general anesthesia providers and critical care facilities in low-income settings.

TRIAL REGISTRATION

Pan African Clinical Trial Registry PACTR202208635457430. Registered on 11^th August 2022. All items from the WHO trial registration data set are within the protocol. Version number and date: version 3, 15/03/2023.

B P, Mohammed SJ, Pereira NJ, Gupta S, K. R S, K. M T. Thyroidectomy Under Regional Anaesthesia: An ORL Perspective

BACKGROUND

The use of regional anaesthesia as an effective alternative to general anaesthesia in thyroid surgeries is now being accepted in many parts of the world. In this day of computers and technology, there is an increased awareness among the people of the available options of anaesthesia and the adverse effects of general anaesthesia. They thus have an inclination to avoid general anaesthesia wherever feasible. This study dwells on the use of regional anaesthesia as an alternative tool that can be offered to the patients undergoing thyroidectomy.

AIMS

This study aims at analysing the effectiveness, safety, ease and patient acceptability of performing thyroidectomies under regional anaesthesia.

SETTINGS AND DESIGN

This prospective study was performed at a university - affiliated hospital.

MATERIALS AND METHODS

Twenty nine patients who underwent thyroidectomy for benign thyroid diseases under regional anaesthesia were included in this study: 20 patients under deep cervical plexus block and 9 patients under cervical epidural anaesthesia.

STATISTICAL ANALYSIS USED

Z-test and validity test.

RESULTS

In our study, all the 29 patients who underwent thyroidectomy under regional anaesthesia found the anaesthesia effective and were comfortable throughout the procedure. The surgeon too was at ease while performing the surgery. No complications were recorded.

CONCLUSION

In our present study, regional anaesthesia (Cervical epidural anaesthesia and Cervical plexus block) has been used safely and effectively in 29 thyroid surgeries. We conclude that although regional anaesthesia has been reserved for high risk thyroidectomies it may be offered as effective alternative to general anaesthesia even in routine thyroid surgeries.

Local anesthesia in thyroid surgery--own experience and literature review

The local anesthesia in thyroid surgery is rarely used, only in selected patients. Majority of centers performing thyroid surgery with local anesthesia have possibility to convert to the general anesthesia. The aim of the study was to present our experiences with partial thyroidectomy under local anesthesia performed in 49 consecutive subjects in the Central African Republic (bilateral subtotal strumectomy, total resection of the one lobe, subtotal resection of the one lobe).

MATERIAL AND METHODS

All admitted patients with clinically significant goiter were accepted for surgical treatment. For infiltration anesthesia 1% lignocaine was used. Because of the shortage of medical resources, potential conversion to the general anesthesia was impossible. Before the operation patients had received an oral sedation and antibiotic. In 16 patients general anesthesia was used, in other 33 it was impossible.

RESULTS

Subtotal bilateral thyroidectomy was performed in 37 patients, 12 patients underwent lobectomy or partial lobectomy of the affected portion of the gland. There were no intraoperative and postoperative complications noticed in the reported group, including complications related to laryngeal nerve injury. The mean duration of the procedure was 127 minutes and mean medical follow-up was 3 days. General condition of all patients on the day of discharge from hospital was good.

CONCLUSIONS

Surgery for goiter under local anesthesia may be a safe alternative where general anesthesia is not available or contraindicated for medical reasons. The infiltration anesthesia is simple to perform and reduces the number of complications potentially occurred at the C2-C4 neck plexus block.

Randomized controlled trial of bilateral superficial cervical plexus block versus placebo in thyroid surgery

Background

Bilateral superficial cervical block during thyroid surgery can reduce postoperative pain but its value is unclear. This randomized clinical trial assessed the efficacy of such regional anaesthesia on postoperative pain after thyroid surgery performed under general anaesthesia.

Methods

Patients undergoing thyroid surgery were randomized to one of four groups in a double-blind fashion. Patients received a cervical block with placebo or bupivacaine at the start or end of surgery. Postoperative pain, analgesic use and length of hospital stay were assessed.

Results

There were 159 patients eligible for analysis. The bupivacaine group had significantly less pain than the placebo group (P = 0·016). The timing of bupivacaine administration did not significantly influence pain (preoperative versus postoperative, P = 0·723). There was no difference between groups in the amount of analgesic used. Length of hospital stay was the same in the bupivacaine and placebo groups (P = 0·925) and when bupivacaine was administered at the beginning or end of surgery (P = 0·087).

Conclusion

Bilateral superficial cervical block with bupivacaine combined with general anaesthesia significantly reduced postoperative pain after thyroid surgery. Registration number: NCT00472446 (http://www.clinicaltrials.gov).