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Betancourt C, Sanabria A. Post-thyroidectomy bilateral cervical plexus block relieves pain: a systematic review. Eur Arch Otorhinolaryngol 2024; 281:3765-3778. [PMID: 38709322 DOI: 10.1007/s00405-024-08626-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/18/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To assess the effectiveness of bilateral superficial cervical plexus block (BSCPB) in treating post-thyroidectomy pain. METHODS MEDLINE, Embase, Google Scholar, LILACS, and the Cochrane Central Register of Controlled Trials, were extensively searched. The search period extended from 1968 until December 2022. Randomized controlled trials comparing BSCPB to placebo, no block in patients with thyroidectomy for benign or malignant thyroid disease were included. Outcomes were pain in the first 24 h after surgery. Analgesic rescue, period before the first rescue dosage, and 24-h opioid usage were secondary outcomes. The RoB 2 instrument was used to evaluate the risk of bias. RESULTS 34 of 354 studies were eligible. There were 2,519 patients. BSCPB reduced the intensity of pain postoperatively [SMD: - 1.17 (95% CI: - 1.54 to - 0.81)] and in the first 24 h [- 0.62 (95%: 0.91 to 0.33)]. A considerable delay for the first opioid dose, rescue analgesics, and postoperative opioid usage was also found. CONCLUSION BSCPB's 24-h analgesic efficacy minimizes the requirement for rescue analgesia, postoperative opioid intake, and rescue analgesia start time. The choice of anesthetic and different application methods might affect its effectiveness.
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Affiliation(s)
- Carlos Betancourt
- Head and Neck Service, Hospital Alma Mater, Medellín, Colombia
- CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Alvaro Sanabria
- Head and Neck Service, Hospital Alma Mater, Medellín, Colombia.
- CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia.
- Department of Surgery, School of Medicine, Universidad de Antioquia, Cra. 51d #62-29, Medellín, Colombia.
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Yang X, Yang H, Li M, Zhu K, Shen L, Xie C. Effect of ultrasound-guided bilateral superficial cervical plexus block versus perioperative intravenous lidocaine infusion on postoperative quality of recovery in patients undergoing thyroidectomy: A randomised double-blind comparative trial. Indian J Anaesth 2024; 68:238-245. [PMID: 38476543 PMCID: PMC10926339 DOI: 10.4103/ija.ija_852_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 03/14/2024] Open
Abstract
Background and Aims Recent studies have found that ultrasound-guided (USG) bilateral superficial cervical plexus block (BSCPB) and intravenous infusion of lidocaine (IVL) have the potential to improve the quality of postoperative recovery. This study aimed to investigate and compare their effects on postoperative quality of recovery in patients undergoing thyroidectomy. Methods A total of 135 patients were randomised to Group N: BSCPB with 10 mL 0.75% ropivacaine on each side, Group L: intravenous lidocaine (1.5 mg/kg for 10 min, followed by 1.5 mg/kg/h) and Group C: intravenous saline combined with BSCPB saline. The primary objective was quality of recovery-40 (QoR-40). Other parameters compared were numeric rating pain scale (NRS) score, haemodynamic data, opioid dosage and incidence of adverse effects. Statistical analysis was performed using the one-way analysis of variance (ANOVA), the Kruskal-Wallis test and the Chi-square test. Results Compared to Group C, both groups N and L had higher QoR-40 total scores as well as scores indicating physical comfort, emotional state and pain dimensions on postoperative day (POD) 1 and POD2 (P < 0.001). The QoR-40 total and pain dimension scores in Group N were higher on POD1 and POD2 (P < 0.05). The NRS scores and the change in haemodynamics were lower in Group N compared to groups L and C (P < 0.05). The results of other parameters were lower in groups N and L than in Group C (P < 0.05). Conclusion USG BSCPB and IVL are comparable in improving the quality of postoperative recovery in patients undergoing thyroidectomy.
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Affiliation(s)
- Xiaoqian Yang
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Jiangsu, China
| | - Hui Yang
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Jiangsu, China
| | - Mengci Li
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Jiangsu, China
| | - Kairun Zhu
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Jiangsu, China
| | - Lulu Shen
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Jiangsu, China
| | - Chenglan Xie
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Jiangsu, China
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3
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Liu Z, Bi C, Li X, Song R. The efficacy and safety of opioid-free anesthesia combined with ultrasound-guided intermediate cervical plexus block vs. opioid-based anesthesia in thyroid surgery-a randomized controlled trial. J Anesth 2023; 37:914-922. [PMID: 37740124 PMCID: PMC10654206 DOI: 10.1007/s00540-023-03254-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE In the context of the current comfort medicine and enhanced recovery after surgery, there is a demand for a new anesthesia method to reduce adverse reactions and accelerate recovery after surgery. This randomized controlled trial aimed to compare the efficacy and safety between opioid-free anesthesia (OFA) combined with ultrasound-guided intermediate cervical plexus block (ICPB) and opioid-based anesthesia in patients after thyroid surgery. METHODS In this study, 75 patients scheduled for thyroid surgery under general anesthesia were randomly allocated into two groups. The primary outcome included the incidence of nausea within 24 h after surgery. The main secondary outcomes included the incidence of vomiting and the visual analog score (VAS) scores within 24 h after surgery as well as the quality of recovery 40 questionnaires (QoR-40) scores 24 h after surgery. RESULTS In the OFA group, the incidence of postoperative nausea was 6.1%, compared to 39.4% in the control group (p = 0.001). No patient presented with postoperative vomiting in the OFA group, while 15.2% of patients suffered from postoperative vomiting in the control group (p = 0.063). The VAS scores of patients in the postanesthetic care unit (PACU) and 2 h, 4 h, and 6 h after surgery were lower in the OFA group, and the difference is statistically significant. Besides, the VAS scores of patients at rest (p = 1.000) and during swallowing (p = 1.000) 24 h after surgery were comparable. CONCLUSION Compared with opioid-based anesthesia, the OFA combined with the ultrasound-guided ICPB can better improve patients' postoperative recovery, reduce nausea, and decrease pain scores. TRIAL REGISTRATION Chinese Clinical Trial Regisrty, ChiCTR2200056344, https://www.chictr.org.cn.
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Affiliation(s)
- Zhi Liu
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
- China Medical University, Shenyang, China
| | - Congjie Bi
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China.
| | - Xingguo Li
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Ruonan Song
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
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Wilson L, Malhotra R, Mayhew D, Banerjee A. The analgesic effects of bilateral superficial cervical plexus block in thyroid surgery: A systematic review and meta-analysis. Indian J Anaesth 2023; 67:579-589. [PMID: 37601928 PMCID: PMC10436725 DOI: 10.4103/ija.ija_806_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 08/22/2023] Open
Abstract
Background and Aims Thyroid surgery is moderately painful, and many techniques to reduce postoperative pain have been studied. Regional techniques are a part of multimodal analgesia employed for various surgical cases. Bilateral superficial cervical plexus block (BSCPB) is a commonly used regional anaesthesia technique for analgesia for thyroid surgery. A previous meta-analysis by this group had left questions about some facets of the technique, to which further trials have contributed. Methods The systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) CRD42022315499. It is an update to a previously published paper in 2018. An updated systematic search, critical appraisal, and analysis of clinical trials were performed. Trials investigating preoperative or postoperative BSCPB compared to control in patients undergoing thyroid surgery were included in the search. The primary outcome was postoperative opioid consumption. The secondary outcomes were the duration of analgesia (time to request of analgesia), Visual Analogue Scale (VAS) pain scores at 0, 4, 12, and 24 h, postoperatively, rates of postoperative nausea and vomiting (PONV), postoperative rescue analgesic consumption, and intraoperative morphine use. Results A total of 31 studies and 2,273 patients were included in this analysis. BSCPB significantly reduced post-thyroidectomy opioid consumption (P < 0.001). Additionally, the duration of analgesia was prolonged following BSCPB. VAS scores for 24 h (postoperatively), intraoperative morphine use, and rescue analgesia (postoperatively) remained significantly lower in patients who received BSCPB. There was also a statistically significant reduction in PONV (P = 0.02). Conclusion BSCPB offers superior postoperative analgesia with a reduction in opioid use, reduction in PONV, and improvement in VAS scores.
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Affiliation(s)
- Laura Wilson
- Department of Anaesthesia, Liverpool University Hospitals NHS Trust, Royal Liverpool University Hospital, Mount Vernon Street, Liverpool, England
| | - Rajiv Malhotra
- Department of Anaesthesia, Liverpool University Hospitals NHS Trust, Royal Liverpool University Hospital, Mount Vernon Street, Liverpool, England
| | - David Mayhew
- Department of Anaesthesia, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, England
| | - Arnab Banerjee
- Department of Anaesthesia, Liverpool University Hospitals NHS Trust, Royal Liverpool University Hospital, Mount Vernon Street, Liverpool, England
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Zhe Xu C, Can G, Xin W, Jiang Sheng H. Drugs used in regional block analgesia for thyroidectomy: A network meta-analysis of randomized controlled trials. Int J Surg 2022; 100:106598. [DOI: 10.1016/j.ijsu.2022.106598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/18/2022] [Accepted: 03/08/2022] [Indexed: 12/15/2022]
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Superiority of non-opioid postoperative pain management after thyroid and parathyroid operations: A systematic review and meta-analysis. Surg Oncol 2022; 41:101731. [DOI: 10.1016/j.suronc.2022.101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 11/20/2022]
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Surekha C, Satish Kumar MN, Archana M, Dayananda VP, Ramachandraiah R. A study to evaluate the efficacy of dexamethasone as an adjuvant in ultrasound-guided bilateral superficial cervical plexus block using 0.25% bupivacaine in patients undergoing thyroid surgeries under entropy-guided general anesthesia. Anesth Essays Res 2022; 16:127-132. [PMID: 36249144 PMCID: PMC9558673 DOI: 10.4103/aer.aer_85_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/14/2021] [Accepted: 03/16/2022] [Indexed: 11/12/2022] Open
Abstract
Context: Ultrasound-guided bilateral superficial cervical plexus block (BSCPB) is a technique described for thyroid surgeries for postoperative analgesia as the surgery can cause severe pain and discomfort. Perineural dexamethasone is known to prolong analgesic duration and reduce postoperative nausea/vomiting. Aims: To assess the efficacy of dexamethasone as an adjuvant to BSCPB with 0.25% bupivacaine on isoflurane consumption, intraoperative hemodynamic parameters, and postoperative analgesia in patients undergoing thyroid surgeries under general anesthesia. Settings and Design: This was a randomized control trial. Subjects and Methods: Eighty patients were randomized to two equal groups using random number table into Group A with BSCPB receiving 20 mL of 0.25% bupivacaine and Group B with BSCPB receiving 19 mL of 0.25% bupivacaine + injection dexamethasone 4 mg in the preinduction period. Hemodynamic parameters, isoflurane consumption, postoperative visual analog scale (VAS) score, and antiemetic effect over 24 h were compared between two groups. Statistical Analysis Used: Microsoft excel data sheet, Chi-square test, and independent t-test were used for statistical analysis. Results: The intraoperative hemodynamic parameters were comparable between the two groups. There was a significant difference in mean VAS score between two groups from 6 h to 20 h postoperatively. The time of rescue analgesic in Group A was 7.09 ± 1.04 min and Group was 13.19 ± 1.46 min with P < 0.0001. In Group A, 40% had nausea and 35% had vomiting, and in Group B, 7.5% had nausea and 5% had vomiting. Conclusions: Preinduction ultrasound-guided BSCPB with bupivacaine and dexamethasone provides longer duration of postoperative analgesia and lesser nausea and vomiting compared to bupivacaine alone.
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8
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El Bendary HM, Abd El-Fattah AM, Ebada HA, Hayes SMS. Levobupivacaine versus levobupivacaine – dexmedetomidine for ultrasound guided bilateral superficial cervical plexus block for upper tracheal resection and reconstruction surgery under general anesthesia. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.2002637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Hanaa M. El Bendary
- Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Al Mansurah, Egypt
| | - Ahmed M Abd El-Fattah
- Oto-Rhino-Laryngology Department, Faculty of Medicine, Mansoura University, Al Mansurah, Egypt
| | - Hisham A Ebada
- Oto-Rhino-Laryngology Department, Faculty of Medicine, Mansoura University, Al Mansurah, Egypt
| | - Salwa MS Hayes
- Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Al Mansurah, Egypt
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Perioperative pain management for thyroid and parathyroid surgery: A systematic review. Am J Surg 2021; 223:641-651. [PMID: 34256931 DOI: 10.1016/j.amjsurg.2021.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/21/2021] [Accepted: 06/27/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION A growing body of evidence suggests that surgeons have historically over-prescribed opioid pain medications following thyroid and parathyroid surgery, thereby potentially contributing to the current US opioid epidemic. We reviewed the evidence supporting multimodal methods of pain control after cervical endocrine surgery. METHODS Fifty-one randomized clinical trials, 9 prospective cohort studies, 7 retrospective studies/reviews, and 1 survey regarding pain management for cervical endocrine surgery were include. RESULTS Most studies reported in-hospital pain scores and opioid consumption. Data on pain scores following discharge were limited. In several studies, the interventional dose was much greater than what is commonly used clinically. CONCLUSION Several evidence-based, non-opioid interventions can be incorporated into a standardized pain management protocol following cervical endocrine surgery. Little is known regarding the effects of these interventions on post-discharge pain scores and patient quality of life during recovery.
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Philteos J, Baran E, Noel CW, Pasternak JD, Higgins KM, Freeman JL, Chiodo A, Eskander A. Feasibility and Safety of Outpatient Thyroidectomy: A Narrative Scoping Review. Front Endocrinol (Lausanne) 2021; 12:717427. [PMID: 34394008 PMCID: PMC8355596 DOI: 10.3389/fendo.2021.717427] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Outpatient thyroid surgery is gaining popularity as it can reduce length of hospital stay, decrease costs of care, and increase patient satisfaction. There remains a significant variation in the use of this practice including a perceived knowledge gap with regards to the safety of outpatient thyroidectomies and how to go about implementing standardized institutional protocols to ensure safe same-day discharge. This review summarizes the information available on the subject based on existing published studies and guidelines. METHODS This is a scoping review of the literature focused on the safety, efficacy and patient satisfaction associated with outpatient thyroidectomies. The review also summarizes and editorializes the most recent American Thyroid Association guidelines. RESULTS In total, 11 studies were included in the analysis: 6 studies were retrospective analyses, 3 were retrospective reviews of prospective data, and 2 were prospective studies. The relative contraindications to outpatient thyroidectomy have been highlighted, including: complex medical conditions, anticipated difficult surgical dissection, patients on anticoagulation, lack of home support, and patient anxiety toward an outpatient procedure. Utilizing these identified features, an outpatient protocol has been proposed. CONCLUSION The salient features regarding patient safety and selection criteria and how to develop a protocol implementing ambulatory thyroidectomies have been identified and reviewed. In conclusion, outpatient thyroidectomy is safe, associated with high patient satisfaction and decreased health costs when rigorous institutional protocols are established and implemented. Successful outpatient thyroidectomies require standardized preoperative selection, clear discharge criteria and instructions, and interprofessional collaboration between the surgeon, anesthetist and same-day nursing staff.
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Affiliation(s)
- Justine Philteos
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Elif Baran
- Undergraduate Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Christopher W. Noel
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jesse D. Pasternak
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kevin M. Higgins
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Jeremy L. Freeman
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Albino Chiodo
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Antoine Eskander
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- *Correspondence: Antoine Eskander,
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Jiang Y, Zhang Z, Liang B, Xu S, Ye Y, Chen R, Li Y, Yu M, Zou Z. The effect of bupivacaine on postoperative pain following thyroidectomy: a systematic review and meta-analysis. MINERVA CHIR 2020; 75:193-202. [PMID: 32550728 DOI: 10.23736/s0026-4733.20.08255-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Thyroid surgery, which is usually followed by moderate postoperative pain, has gained increasing attention in recent years. A systematic review and meta-analysis was conducted to assess the effect of prophylactic bupivacaine on postoperative pain following thyroidectomy. EVIDENCE ACQUISITION We searched the PubMed, Web of Science, Embase, and Cochrane Library databases for specific keywords. RevMan 5.0 and Stata 12.0 software were used to perform meta-analyses. The endpoints were postoperative pain, rescue analgesic requirement, and postoperative nausea and vomiting (PONV) during the immediate 24 h postoperative period. EVIDENCE SYNTHESIS A total of 18 randomized controlled trials (RCTs) with 1308 patients were included in the meta-analysis. A significant reduction of pain according to the postoperative pain scale at 1 hour (P<0.05) and rescue analgesic requirement (P<0.05) was observed following local infiltration with bupivacaine. A bilateral superficial cervical plexus block (BSCPB) with bupivacaine also significantly reduced postoperative pain at 1 hour (P<0.01) and 24 hours (P<0.01), as well as rescue analgesic requirement (P<0.00001) and PONV (P<0.01). Compared with BSCPB, local infiltration with bupivacaine provides a better effect in terms of postoperative analgesia (P<0.05). CONCLUSIONS We recommend local infiltration with bupivacaine ranged from 20 to 75 mg before or after skin closure or BSCPB with bupivacaine ranged from 25 to 100 mg to reduce postoperative pain after thyroidectomy.
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Affiliation(s)
- Yaofei Jiang
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China.,Hubei Key Laboratory of Tumor Biology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Zulei Zhang
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China.,Nanchang University, Nanchang, China
| | - Bo Liang
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Suming Xu
- Nanchang University, Nanchang, China
| | - Yuan Ye
- Nanchang University, Nanchang, China
| | | | - Yimin Li
- Nanchang University, Nanchang, China
| | - Mengqi Yu
- Nanchang University, Nanchang, China
| | - Zhenhong Zou
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China -
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12
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Anesthetic and Analgesic Efficient of Regional Nerve Blockade in Otoplasty. J Craniofac Surg 2020; 31:1951-1954. [PMID: 32371690 DOI: 10.1097/scs.0000000000006501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIM The prominent ear is the most common congenital deformity of the external ear. Otoplasty is performed to correct the appearance of the prominent ear. This study was planned to compare the analgesic and anesthetic effects of local nerve blockade and local infiltration anesthesia in the otoplasties. METHOD Thirty-two patients who underwent otoplasty in both ears between February 2018 and March 2019 were included in the study. Three patients were excluded because they refused regional anesthesia. In the patients included in the study, only local infiltration anesthesia was applied to 1 ear and regional nerve blockade was applied to the other ear. Regional nerve blockade was applied to the study group; local infiltration anesthesia was applied to the control group. Surgical and anesthetic complications were recorded. The onset time, duration and severity of pain were followed. Numerical evaluation scale scores were used to evaluate pain levels. RESULTS It was observed that the first pain of the patients On the side where regional nerve block (RNB) anesthesia was applied after an average of 10.5 hours. On the other hand on the side where local infiltration anesthesia was applied; the pain was observed to start after an average of 3.5 hours. At the 6th and 12th hours postoperatively, the scores of the numerical evaluation scale were significantly lower in the study group than the control group (P < 0.05). At the 24th-hour pain score, the values were lower in the study group, but the difference was not significant between the groups (P > 0.05). In the regional anesthesia group, can develop such as difficulty in swallowing, weakness in the neck, weakness in the upper extremity, nausea, Horner syndrome; but all side effects resolve spontaneously within 6 to 12 hours. CONCLUSION The application of regional anesthesia in prominent ear surgical procedures can be considered as an alternative method to provide better quality preoperative anesthesia and better quality postoperative analgesia in patients.
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Woldegerima YB, Hailekiros AG, Fitiwi GL. The analgesic efficacy of bilateral superficial cervical plexus block for thyroid surgery under general anesthesia: a prospective cohort study. BMC Res Notes 2020; 13:42. [PMID: 31992341 PMCID: PMC6986007 DOI: 10.1186/s13104-020-4907-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/14/2020] [Indexed: 11/26/2022] Open
Abstract
Objective Uses of simple analgesics were found insufficient to manage pain after thyroid surgery. We hypothesized that using bilateral superficial cervical plexus block (BSCPB) might influence the pattern of immediate postoperative pain and analgesic consumption. The general objective of the study was to assess the analgesic efficacy of bilateral superficial plexus block for thyroid surgery under general anesthesia. Results A total of 74 willing patients involved. Half of them had received BSCPB with 10 ml of 0.25% bupivacaine just before induction and the remaining half did not. Postoperatively, patients were assessed at immediate, 2nd, 6th, 12th and 24th h. At all endpoints, NRS-11 scores for pain were significantly lower in the block group. The time to first analgesic requirement was significantly longer 132.3 ± 71.5 min vs 71.4 ± 60.0 min, p = 0.009. Opioid and total analgesic consumption were reduced by BSCPB in the first 24 postoperative hours. There was low but non-significant rate of PONV in the block group. No clinically important adverse event was noted related to BSCPB. Trial registration The study was registered in Pan African Clinical Trial Registry on 13/01/2020 and the registration number is PACTR202001579588451. Retrospectively registered.
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Affiliation(s)
- Yophtahe B Woldegerima
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, 196, Ethiopia.
| | - Amare G Hailekiros
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, 196, Ethiopia
| | - Girmay L Fitiwi
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, 196, Ethiopia
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14
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Yao Y, Lin C, He Q, Gao H, Jin L, Zheng X. Ultrasound-guided bilateral superficial cervical plexus blocks enhance the quality of recovery in patients undergoing thyroid cancer surgery: A randomized controlled trial. J Clin Anesth 2019; 61:109651. [PMID: 31761416 DOI: 10.1016/j.jclinane.2019.109651] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/25/2019] [Accepted: 11/11/2019] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE Regional anesthesia can improve postoperative analgesia and enhance the quality of recovery (QoR) after surgery. This trial evaluates the effects of ultrasound-guided bilateral superficial cervical plexus block (SCPB) on QoR in patients undergoing thyroid cancer surgery. DESIGN Prospective, randomized, double-blinded, placebo-controlled trial. SETTING Operating room. PATIENTS Seventy-four ASA I-II female patients scheduled for thyroid cancer surgery were included to the study. INTERVENTIONS Patients were randomly allocated to receive pre-operative ultrasound-guided bilateral SCPB with 10 ml of ropivacaine 0.5% or normal saline on each side. MEASUREMENTS The primary endpoint was the quality of recovery, which was assessed using the 15-item quality of recovery questionnaire (QoR-15). Secondary endpoints were acute postoperative pain, time to first rescue analgesia, the number of patients requiring rescue analgesia, length of post-anesthesia care unit (PACU) stay, the incidence of postoperative nausea or vomiting (PONV) and dizziness, and patient satisfaction. MAIN RESULTS The global QoR-15 score at 24 h postoperatively was significantly higher in the SCPB group (Median [IQR], 118 [115-120]) than the control group (110 [106-112]) with a median difference of 8 (95% CI: 6 to 10, P < .001). Compared with the control group, pre-operative ultrasound-guided bilateral SCPB reduced postoperative pain up to 24 h and the incidence of PONV, as well as the length of PACU stay. Additionally, the patient satisfaction scores were improved in the SCPB group (P = .024). CONCLUSION Pre-operative ultrasound-guided bilateral SCPB with ropivacaine enhances the quality of recovery, postoperative analgesia and patient satisfaction, alleviates the incidence of PONV, and accelerates the PACU discharge following thyroid cancer surgery.
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Affiliation(s)
- Yusheng Yao
- Department of Anesthesiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Cailing Lin
- Department of Oncological Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Qiaolan He
- Department of Anesthesiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Hongxin Gao
- Department of Anesthesiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Lufen Jin
- Department of Anesthesiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaochun Zheng
- Department of Anesthesiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China; Department of Anesthesiology, Fujian Provincial Hospital & Fujian Provincial Emergency Center, Fuzhou, Fujian, China.
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Analgesic efficacy of ultrasound guided versus landmark-based bilateral superficial cervical plexus block for thyroid surgery. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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16
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Analgesic efficacy of bilateral superficial cervical plexus block for thyroid surgery: meta-analysis and systematic review. Br J Anaesth 2018; 120:241-251. [DOI: 10.1016/j.bja.2017.11.083] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 08/17/2017] [Accepted: 10/27/2017] [Indexed: 11/22/2022] Open
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17
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Elmaddawy AEA, Mazy AE. Ultrasound-guided bilateral superficial cervical plexus block for thyroid surgery: The effect of dexmedetomidine addition to bupivacaine-epinephrine. Saudi J Anaesth 2018; 12:412-418. [PMID: 30100840 PMCID: PMC6044169 DOI: 10.4103/sja.sja_653_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The thyroid gland surgery is a common and painful procedure demanding analgesia. Many regional techniques are applied for anterior neck surgeries mostly assigned in relation to the involved cervical fascia. Dexmedetomidine (Precedex) is a selective alpha 2 adrenoceptor agonist which prolongs the sensory blockade duration of local anesthetics. Our study hypothesis is that ultrasound (US)-guided bilateral superficial cervical plexus block (BSCPB) may provide longer analgesia when adding dexmedetomidine to bupivacaine-epinephrine. Purpose: The aim of this study is to evaluate the analgesic efficacy and possible side effects of US-guided BSCPB and the effect of dexmedetomidine addition to bupivacaine-epinephrine in patients undergoing thyroid surgery. Methods: This prospective, double-blind, randomized study was performed on 42 patients randomized into two equal groups each of 21; bupivacaine Group B and dexmedetomidine Group D. Patients with contraindications to regional anesthesia or uncontrolled comorbidities were excluded from the study. Total pethidine consumption in 24 h is the primary outcome. The visual analog scale, timing of the first opioid request, and hemodynamics are the secondary outcomes. Results: In Group D, there was a longer time to the first request of opioid postoperatively, a lower total pethidine consumption and pain score postoperatively, and lower fentanyl requirements intraoperatively. Conclusions: Sonographic-guided bilateral SCPB using a combination of bupivacaine, dexmedetomidine, and epinephrine was superior to bupivacaine for prolonged analgesia with less intra- and postoperative opioid consumption and lower side effect profile during thyroid surgery.
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Affiliation(s)
- Alaa Eldin Adel Elmaddawy
- Department of Anesthesia, Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Alaa Eldin Mazy
- Department of Anesthesia, Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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18
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Senapathi TGA, Widnyana IMG, Aribawa IGNM, Wiryana M, Sinardja IK, Nada IKW, Jaya AGPS, Putra IGKS. Ultrasound-guided bilateral superficial cervical plexus block is more effective than landmark technique for reducing pain from thyroidectomy. J Pain Res 2017; 10:1619-1622. [PMID: 28761368 PMCID: PMC5516880 DOI: 10.2147/jpr.s138222] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose Thyroidectomy causes postoperative pain and patient discomfort. Bilateral superficial cervical plexus block is a regional anesthesia technique that can provide analgesia during and after surgery. This study aims to compare the effectiveness of ultrasound (US)-guided versus landmark (LM) technique for bilateral superficial cervical plexus block in thyroidectomy. Patients and methods Thirty-six patients undergoing thyroidectomy were divided into two groups randomly (n=18); either US-guided (US group) or LM technique (LM group) for bilateral superficial cervical plexus block. Patient-controlled analgesia was used to control postoperative pain. Intraoperative opioid rescue, postoperative visual analog scale (VAS) score and opioid consumption were measured. Results The number of patients who required intraoperative opioid rescue was significantly lower in the US group (p≤0.05). There was no significant difference in postoperative VAS score at 3 hours (p>0.05), but postoperative VAS score at 6 and 24 hours was significantly lower in the US group (p≤0.05). Twenty-four hour postoperative opioid consumption was significantly lower in the US group (p≤0.05). Conclusion Ultrasound-guided bilateral superficial cervical plexus block is more effective in reducing pain both intra- and postoperatively compared with landmark technique in patients undergoing thyroidectomy.
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Affiliation(s)
- Tjokorda Gde Agung Senapathi
- Department of Anesthesiology and Intensive Care, Sanglah Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - I Made Gede Widnyana
- Department of Anesthesiology and Intensive Care, Sanglah Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - I Gusti Ngurah Mahaalit Aribawa
- Department of Anesthesiology and Intensive Care, Sanglah Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - Made Wiryana
- Department of Anesthesiology and Intensive Care, Sanglah Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - I Ketut Sinardja
- Department of Anesthesiology and Intensive Care, Sanglah Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - I Ketut Wibawa Nada
- Department of Anesthesiology and Intensive Care, Sanglah Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - Aa Gde Putra Semara Jaya
- Department of Anesthesiology and Intensive Care, Sanglah Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - I Gede Koko Swadharma Putra
- Department of Anesthesiology and Intensive Care, Sanglah Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
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19
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Miu M, Royer C, Gaillat C, Schaup B, Menegaux F, Langeron O, Riou B, Aubrun F. Lack of Analgesic Effect Induced by Ropivacaine Wound Infiltration in Thyroid Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial. Anesth Analg 2016; 122:559-64. [PMID: 26505570 DOI: 10.1213/ane.0000000000001041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Surgical site infiltration with local anesthetic reduces analgesic requests in various types of surgeries. Because thyroid surgery may induce severe postoperative pain, we tested the hypothesis that ropivacaine surgical site infiltration would significantly decrease postoperative administration of morphine in patients undergoing thyroid surgery. METHODS We performed a double-blind, placebo-controlled superiority trial to assess the efficacy of surgical site analgesia with ropivacaine (10 mL, 75 mg) performed at the end of thyroid surgery in adult patients. The primary end point was the proportion of patients not requiring IV morphine in the postanesthesia care unit. RESULTS One hundred sixty-three patients completed the study, 85 in the placebo group and 88 in the ropivacaine group. The proportion of patients requiring morphine administration in the postanesthesia care unit (55% vs 53%, P = 0.80), the dose of IV morphine administered (5.6 ± 6.1 vs 5.5 ± 6.0 mg, P = 0.90), the total dose of opioids administered (expressed as oral morphine equivalent dose: 64 ± 27 vs 69 ± 29 mg, P = 0.20), and the visual analog pain scale over the first 24 hours were not significantly different between groups. The incidence of adverse events (36% vs 39%, P = 0.88), morphine-related adverse events (19% vs 17%, P = 0.84), serious adverse events (0% vs 2%, P = 0.50), and the patient satisfaction scores (9 ± 1 vs 9 ± 1, P = 0.70) was not significantly different between the 2 groups. CONCLUSIONS Surgical site analgesia with ropivacaine at the end of thyroid surgery is not associated with any significant analgesic benefit.
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Affiliation(s)
- Mihaela Miu
- From the Departments of *Anesthesia and Critical Care, †General Surgery, and ‡Emergency Medicine, Pitié-Salpetrière Hospital, Pierre et Marie Curie University, Paris, France; and §Department of Anesthesia and Critical Care, Croix-Rousse Hospital, Claude Bernard Lyon 1 University, Lyon, France
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Kale S, Aggarwal S, Shastri V, Chintamani. Evaluation of the Analgesic Effect of Bilateral Superficial Cervical Plexus Block for Thyroid Surgery: A Comparison of Presurgical with Postsurgical Block. Indian J Surg 2016; 77:1196-200. [PMID: 27011535 DOI: 10.1007/s12262-015-1244-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 02/02/2015] [Indexed: 10/24/2022] Open
Abstract
Bilateral superficial cervical plexus block may help in reduction of postthyroidectomy pain. The aim of this study was to evaluate the influence of bilateral superficial cervical plexus block (BSCB) given either presurgically or postsurgically on analgesia in postthyroidectomy patients. Sixty adult euthyroid patients were randomly allocated to one of the three groups, to receive BSCB either presurgically (group A) or postsurgically (group B). Both of the above groups were compared with parenteral analgesics (group C). Thyroid surgery was performed according to a standardised procedure. Postoperative pain was assessed by visual analog scale (VAS), with 10 being the worst pain and 0 being no pain, when patient was fully awake and extubated (0) and after 1, 2, 4, 8, 12, 18, 24, 36 and 48 h. VAS was assessed at four phases: at rest, neck movements, vocalisation and swallowing. Total use of intraoperative fentanyl was noted. The time for first rescue analgesic was also noted. There was no significant statistical difference amongst three groups as regards demographic data and duration of surgery. Patients given BSCBs (either presurgically or postsurgically) had significant lower VAS at all four phases of pain assessment as compared to group C. The time for first rescue analgesia was the earliest in group C. We concluded that BSCB whether given presurgically or postsurgically significantly reduce pain intensity and opioids requirement in postoperative period after thyroid surgery.
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Affiliation(s)
- Suniti Kale
- Department of Anesthesiology and Intensive Care, Safdarjung Hospital, New Delhi, 110029 India
| | - Shipra Aggarwal
- Department of Anesthesiology and Intensive Care, Safdarjung Hospital, New Delhi, 110029 India
| | - Vineet Shastri
- Department of Anesthesiology and Intensive Care, Safdarjung Hospital, New Delhi, 110029 India
| | - Chintamani
- Department of Anesthesiology and Intensive Care, Safdarjung Hospital, New Delhi, 110029 India
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21
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Su Y, Zhang Z, Zhang Q, Zhang Y, Liu Z. Analgesic efficacy of bilateral superficial and deep cervical plexus block in patients with secondary hyperparathyroidism due to chronic renal failure. Ann Surg Treat Res 2015; 89:325-9. [PMID: 26665128 PMCID: PMC4672097 DOI: 10.4174/astr.2015.89.6.325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/07/2015] [Accepted: 08/18/2015] [Indexed: 12/03/2022] Open
Abstract
Purpose Secondary hyperparathyroidism (SHPT) develops in patients with chronic renal failure. This study aimed to compare analgesic efficacy in SHPT patients who undergo subtotal parathyroidectomy after superficial versus deep cervical plexus block. Methods Sixty chronic renal failure patients with SPHT scheduled for subtotal parathyroidectomy were randomized to receive general anesthesia (group GA), general anesthesia plus bilateral superficial and deep cervical plexus block (group BD), or general anesthesia plus bilateral superficial cervical plexus block (group BS) (n = 20). Bilateral superficial cervical plexus block or combined superficial and deep cervical plexus block with 0.5% ropivacaine was administered. Postoperative pain was assessed using visual analogue scale (VAS). Results VAS score at 1 hour, 4 hours, and 8 hours after operation was 3.71 ± 0.60, 2.72 ± 0.54, 2.17 ± 0.75 in BS group; 4.00 ± 0.28, 2.89 ± 0.21, and 2.46 ± 1.01 in BD group, significantly lower than in GA group (6.50 ± 0.50, 5.02 ± 0.54, and 4.86 ± 0.51, respectively). The dosage of tramadol was 109.0 ± 35.2 mg in BS group and 93.0 ± 24.52 mg in BD group, significantly lower than in GA group (300.0 ± 27.13 mg). The incidence of complications in GA group (90%) was significantly higher than in BS group (30%) and BD group (15%). Serum glucose and norepinephrine levels were significantly higher at 1 hour, 4 hours, and 8 hours after operation, but returned to baseline levels at 24 hours after operation. Conclusion Superficial cervical plexus block or combined superficial and deep cervical plexus block effectively reduces postoperative pain, stress response, and complications in SHPT patients who undergo subtotal parathyroidectomy.
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Affiliation(s)
- Yinglan Su
- Department of Anesthesiology, The Second Clinical Medical College of JiNan University, Shenzhen People's Hospital, Shenzhen, China
| | - Zhongjun Zhang
- Department of Anesthesiology, The Second Clinical Medical College of JiNan University, Shenzhen People's Hospital, Shenzhen, China
| | - Qiuli Zhang
- Department of Anesthesiology, The Second Clinical Medical College of JiNan University, Shenzhen People's Hospital, Shenzhen, China
| | - Yaoxian Zhang
- Department of Anesthesiology, The Second Clinical Medical College of JiNan University, Shenzhen People's Hospital, Shenzhen, China
| | - Zhanli Liu
- Department of Anesthesiology, The Second Clinical Medical College of JiNan University, Shenzhen People's Hospital, Shenzhen, China
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22
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Bilateral superficial cervical plexus block combined with bilateral greater occipital nerve block reduces the impact of different sources of pain after thyroid surgery with less consumption of morphine-PCA: a randomized trial. Eur Surg 2015. [DOI: 10.1007/s10353-015-0322-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Kessler J, Marhofer P, Hopkins P, Hollmann M. Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years. Br J Anaesth 2015; 114:728-45. [DOI: 10.1093/bja/aeu559] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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24
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Iacobone M, Citton M, Zanella S, Scarpa M, Pagura G, Tropea S, Galligioni H, Ceccherelli F, Feltracco P, Viel G, Nitti D. The effects of acupuncture after thyroid surgery: A randomized, controlled trial. Surgery 2014; 156:1605-12; discussion 1612-3. [PMID: 25456960 DOI: 10.1016/j.surg.2014.08.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 08/20/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acupuncture is a safe and well-tolerated treatment for pain relief. Previous studies supported the effectiveness of several acupuncture techniques for postoperative pain. The aim of this randomized, controlled trial was to evaluate the efficacy of acupuncture in reducing pain after thyroid surgery. METHODS We randomized 121 patients to a control group (undergoing only standard postoperative analgesic treatment with acetaminophen) and an acupuncture group, undergoing also either electroacupuncture (EA) or traditional acupuncture (TA). Pain was measured according to intraoperative remifentanil use, acetaminophen daily intake, Numeric Rating Scale (NRS), and McGill Pain Questionnaire on postoperative days (POD) 1-3. RESULTS Acupuncture group required less acetaminophen than controls at POD 2 (P = .01) and 3 (P = .016). EA patients required less remifentanil (P = .032) and acetaminophen than controls at POD 2 (P = .004) and 3 (P = .008). EA patients showed a trend toward better NRS and McGill scores from POD 1 to 3 compared with controls. EA patients had a lower remifentanil requirement and better NRS and McGill scores than TA patients. No differences occurred between TA patients and controls. CONCLUSION Acupuncture may be effective in reducing pain after thyroid surgery. EA is more useful; TA achieves no significant effects.
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Affiliation(s)
- Maurizio Iacobone
- Minimally Invasive Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
| | - Marilisa Citton
- Minimally Invasive Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Simone Zanella
- Minimally Invasive Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Marco Scarpa
- Surgical Oncology Unit, Veneto Institute of Oncology, Padua, Italy
| | - Giulia Pagura
- Minimally Invasive Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Saveria Tropea
- Minimally Invasive Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Helmut Galligioni
- Anesthesia and Intensive Care Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Francesco Ceccherelli
- Anesthesia and Intensive Care Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Paolo Feltracco
- Anesthesia and Intensive Care Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Giovanni Viel
- Minimally Invasive Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Donato Nitti
- Minimally Invasive Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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25
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Ultrasound guided bilateral cervical plexus block reduces postoperative opioid consumption following thyroid surgery. J Clin Monit Comput 2014; 29:579-84. [DOI: 10.1007/s10877-014-9635-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 10/20/2014] [Indexed: 11/27/2022]
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Egan RJ, Hopkins JC, Beamish AJ, Shah R, Edwards AG, Morgan JDT. Randomized clinical trial of intraoperative superficial cervical plexus block versus incisional local anaesthesia in thyroid and parathyroid surgery. Br J Surg 2013; 100:1732-8. [DOI: 10.1002/bjs.9292] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2013] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Moderate wound pain and opiate analgesia requirement is reported following thyroid and parathyroid surgery. A randomized clinical trial was performed to investigate whether intraoperative superficial cervical plexus block (SCPB) would decrease postoperative pain and analgesia use.
Methods
Patients were randomized to incisional local anaesthesia (control) or incisional local anaesthesia plus intraoperative SCPB. The primary outcome measure was pain, assessed by a visual analogue scale (VAS). Secondary outcome measures were analgesia use (strong opiates defined as having potency at least as strong as that of oral morphine), respiratory rate and sedation score. Primary outcome measures were analysed with non-parametric tests, as well as with receiver operating characteristic (ROC) curves calculated as area under the curve (AUC) to discriminate between trial limbs.
Results
Twenty-nine patients were randomized to each group. Pain (VAS) scores were lower in patients who received intraoperative SCPB than in controls 30 min after surgery and subsequently (P < 0·020 at all time points), with a median pain score of zero on the day of operation in the SCPB group. Corresponding analysis of ROC curves showed differences between groups at 30 min (AUC = 0·722, P = 0·012), 90 min (AUC = 0·747, P = 0·005), 150 min (AUC = 0·803, P < 0·001) and 210 min (AUC = 0·849, P < 0·001) after surgery, and at 07.00 hours on postoperative day 1 (AUC = 0·710, P = 0·017). Fewer patients in the SCPB group required strong opiates (5 of 29 versus 16 of 29 in the control group; P = 0·003) and rescue opiates (6 of 29 versus 20 of 29; P < 0·001).
Conclusion
Intraoperative SCPB reduces pain scores following thyroid and parathyroid surgery, and reduces the requirement for strong and rescue opiates. Registration number: 2009-012671-98 (https://www.clinicaltrialsregister.eu).
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Affiliation(s)
- R J Egan
- Department of Endocrine and General Surgery, Southmead Hospital, Bristol, UK
| | - J C Hopkins
- Department of Endocrine and General Surgery, Southmead Hospital, Bristol, UK
| | - A J Beamish
- Department of General Surgery, Nevill Hall Hospital, Abergavenny, UK
| | - R Shah
- Department of Endocrine and General Surgery, Southmead Hospital, Bristol, UK
| | - A G Edwards
- Department of Endocrine and General Surgery, Southmead Hospital, Bristol, UK
| | - J D T Morgan
- Department of Endocrine and General Surgery, Southmead Hospital, Bristol, UK
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Taleb A, Zetlaoui P, Benhamou D. Lobo-isthmectomie droite chez une patiente atteinte d’une HTAP idiopathique sévère sous bloc intermédiaire échoguidé bilatéral antérieur du plexus cervical superficiel. ACTA ACUST UNITED AC 2013; 32:707-10. [DOI: 10.1016/j.annfar.2013.07.800] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/02/2013] [Indexed: 11/26/2022]
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Karthikeyan VS, Sistla SC, Badhe AS, Mahalakshmy T, Rajkumar N, Ali SM, Gopalakrishnan S. Randomized controlled trial on the efficacy of bilateral superficial cervical plexus block in thyroidectomy. Pain Pract 2012; 13:539-46. [PMID: 23279371 DOI: 10.1111/papr.12022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 11/06/2012] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVE As thyroid surgery is being performed as an ambulatory procedure, recent studies concerning post thyroidectomy analgesia have focused on regional techniques such as bilateral superficial cervical plexus block (BSCPB) and bilateral combined superficial and deep cervical plexus block. But, data regarding the efficacy of BSCPB are controversial. Hence we compared the efficacy of BSCPB with 0.25% bupivacaine with and without clonidine in thyroidectomy, as preventative analgesia. METHODS Patients (n = 60) undergoing thyroidectomy were randomized into 3 groups (n = 20 each) to receive BSCPB using 15 mL of 0.25% bupivacaine (group B) or 0.25% bupivacaine with 1 μg/kg clonidine (group BC) or 0.9% normal saline (group S) on each side after induction. Intraoperative (fentanyl) and postoperative (morphine) analgesic requirements were assessed. Postoperative pain scores, nausea, vomiting, and sedation were assessed for 24 hours. RESULTS Intraoperative fentanyl requirement was significantly lesser in groups B and BC (P = 0.012). Postoperative pain scores were significantly lower in group BC (compared to S) at 2 (P = 0.002), 4 (P = 0.016), and 8 (P = 0.012) hours. First analgesic requirement time (min) was significantly higher in groups B and BC (P = 0.002), and postoperative morphine requirement was significantly lower in groups B and BC (P = 0.001). Incidence of postoperative vomiting was significantly reduced in group BC (P = 0.022). CONCLUSION BSCPB with 0.25% bupivacaine with or without clonidine is effective in reducing both intraoperative and postoperative pain and analgesic requirements in thyroidectomy, and adding clonidine to bupivacaine reduces postoperative vomiting.
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Cai HD, Lin CZ, Yu CX, Lin XZ. Bilateral Superficial Cervical Plexus Block Reduces Postoperative Nausea and Vomiting and Early Postoperative Pain after Thyroidectomy. J Int Med Res 2012; 40:1390-8. [PMID: 22971490 DOI: 10.1177/147323001204000417] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE: To compare the incidence of postoperative nausea and vomiting (PONV) and postoperative pain in thyroidectomy patients undergoing general anaesthesia, with or without bilateral superficial cervical plexus block (BSCPB). METHODS: In this prospective, randomized, double-blind study, adult patients scheduled for thyroid surgery under general anaesthesia were randomized to receive BSCPB with 20 ml 0.5% ropivacaine (ropivacaine group) or placebo (20 ml saline; saline group) before surgery. The incidence of PONV and postoperative pain, and the need for rescue antiemetics were assessed at 0 – 24 h postoperatively. RESULTS: Data from 135 patients were evaluated and the incidence of PONV, the need for rescue antiemetics and the number of patients needing additional perioperative pain relief in the postanaesthetic care unit were significantly lower in the ropivacaine group compared with the saline group. Early postoperative (0 – 8 h) visual analogue scale pain scores were significantly lower in the ropivacaine group compared with the saline group. CONCLUSIONS: BSCPB with 0.5% ropivacaine administered before surgery can significantly reduce the incidence of PONV and early postoperative pain and also reduce perioperative opioid requirements in thyroidectomy patients undergoing general anaesthesia.
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Affiliation(s)
- H-D Cai
- Department of Anaesthesiology, First Affiliated Hospital of Fujian Medical University, Fujian, China
- Department of Pharmacology, Fujian Medical University, Fujian, China
| | - C-Z Lin
- Department of Anaesthesiology, First Affiliated Hospital of Fujian Medical University, Fujian, China
| | - C-X Yu
- Department of Pharmacology, Fujian Medical University, Fujian, China
| | - X-Z Lin
- Department of Anaesthesiology, First Affiliated Hospital of Fujian Medical University, Fujian, China
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Cowlishaw PJ, Scott DM, Barrington MJ. The role of regional anaesthesia techniques in the management of acute pain. Anaesth Intensive Care 2012; 40:33-45. [PMID: 22313062 DOI: 10.1177/0310057x1204000105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Regional anaesthesia and analgesia techniques are used to effectively manage acute pain after a variety of surgeries. With the rapid growth of ultrasound-guided procedures, anaesthetists are re-examining regional anaesthesia and analgesia and their roles in pain management. In this evolving field previous published data may not reflect current practice. Therefore, a narrative review of recent literature was undertaken to establish the current utility and efficacy of regional anaesthesia and analgesia for the management of acute pain following surgery. Only prospective randomised controlled trials published between March 2009 and March 2011 with outcome measures of analgesia efficacy were included. Sixty-five randomised controlled trials were identified involving 4841 patients. Regional techniques for the management of knee (26%), abdominal (26%) and shoulder (14%) surgery were most frequently studied. The review provides further evidence that regional anaesthesia and analgesia can offer excellent analgesia with acceptable side-effects for the management of postsurgical pain. In addition, the results of this review support the use of ultrasound guidance when performing regional techniques and continuous catheter techniques to prolong analgesia.
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Affiliation(s)
- Phillip J Cowlishaw
- Department of Anaesthesia, Mater Misericordiae Health Services, Brisbane, Queensland, Australia.
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31
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Warschkow R, Tarantino I, Jensen K, Beutner U, Clerici T, Schmied BM, Steffen T. Bilateral superficial cervical plexus block in combination with general anesthesia has a low efficacy in thyroid surgery: a meta-analysis of randomized controlled trials. Thyroid 2012; 22:44-52. [PMID: 22142371 DOI: 10.1089/thy.2011.0260] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A combination of bilateral superficial cervical plexus block (BSCPB) and general anesthesia is recommended for thyroid surgery. Proof of the efficacy of this combination remains weak. Furthermore, data on the safety of this regimen are lacking. Therefore, a meta-analysis of randomized controlled trials (RCT) to evaluate the efficacy and safety of BSCPB as an adjunct to general anesthesia in patients receiving thyroid surgery was performed. METHODS A meta-analysis of RCT was performed that included interventional groups evaluating the efficacy of BSCPB 6 and 24 hours after thyroid surgery. RESULTS Eight RCT, including a total of 799 patients (463 who underwent BSCPB and 336 controls), were analyzed. A meta-analysis demonstrated a reduction in pain scores 6 hours (Hedges' g: -0.46 [95% CI: -0.74 to -0.19]; p=0.001) and 24 hours postoperatively (Hedges' g: -0.49 [95% CI: -0.71 to -0.27]; p<0.001) in patients who had undergone BSCPB. The relative risk for postoperative nausea and vomiting (PONV) was 0.80 (95% CI: 0.58 to 1.09, p=0.159) in patients receiving BSCPB. Procedure-related adverse events were reported in three of the 476 patients who had undergone BSCPB (0.6%; 95% CI: 0.1% to 2.0%). These three patients had transient paresis of the brachial plexus, combined with a diaphragmatic paresis in one case, and all spontaneously resolved. CONCLUSION The combination of BSCPB and general anesthesia has a significant benefit in reducing pain 6 and 24 hours after thyroid surgery. However, the effect on pain reduction is too small to be of clinical relevance. Although it is a safe procedure, the existing evidence allows for no recommendation concerning the application of BSCPB in thyroid surgery. Further trials should evaluate a dose-response relationship and the incidence of PONV with this regimen.
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Affiliation(s)
- Rene Warschkow
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Cheng LHH, Hutchison IL. Thyroid surgery. Br J Oral Maxillofac Surg 2011; 50:585-91. [PMID: 22192610 DOI: 10.1016/j.bjoms.2011.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 11/03/2011] [Indexed: 11/17/2022]
Abstract
Diseases of the thyroid are common and surgical treatment is often the preferred option. Thyroid surgery is becoming subspecialised and falls within the repertoire of maxillofacial, and head and neck surgeons. Multidisciplinary management of most patients with diseases of the thyroid is key to providing the best care particularly for those with malignancies and retrosternal extension. To reduce postoperative complications a meticulous search for, and protection of the recurrent laryngeal nerve and parathyroid glands, with an incision along the skin crease in the lower neck, which can be extended for neck dissection, are paramount. Recent advances in thyroid surgery include ultrasound-guided cervical plexus block, use of the Harmonic Scalpel(®) (Ethicon Endo-Surgery, Inc., USA), intraoperative nerve stimulation to monitor the recurrent laryngeal nerve, use of TissuePatch™ 3 (Tissuemed Ltd., Leeds, UK) adhesive sealant, and minimal access surgery.
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Affiliation(s)
- Leo H-H Cheng
- Oral and Maxillofacial Surgery, St Bartholomew's & The Royal London, United Kingdom; Homerton University Hospitals, London, United Kingdom.
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McGuirk S, Fahy C, Costi D, Cyna AM. Use of invasive placebos in research on local anaesthetic interventions. Anaesthesia 2011; 66:84-91. [PMID: 21254982 DOI: 10.1111/j.1365-2044.2010.06560.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Placebos play a vital role in clinical research, but their invasive use in the context of local anaesthetic blocks is controversial. We assessed whether recently published randomised controlled trials of local anaesthetic blocks risked harming control group patients in contravention of the Declaration of Helsinki. We developed the 'SHAM' (Serious Harm and Morbidity) scale to assess risk: grade 0 = no risk (no intervention); grade 1 = minimal risk (for example, skin allergy to dressing); grade 2 = minor risk (for example, subcutaneous haematoma, infection); grade 3 = moderate risk (with or without placebo injection) (for example, neuropraxia); and grade 4 = major risk (such as blindness, pneumothorax, or liver laceration). Placebo interventions of the 59 included trials were given a SHAM grade. Nine hundred and nineteen patients in 31 studies, including six studies with 183 children, received an invasive placebo assessed as SHAM grade ≥ 3. A high level of agreement (78%, κ = 0.80, p < 0.001) for SHAM grades 0-4 increased to 100% following discussion between assessors. More than half of the randomised controlled study designs subjected patients in control groups to risks of serious or irreversible harm. A debate on whether it is justifiable to expose control group patients to risks of serious harm is overdue.
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Affiliation(s)
- S McGuirk
- Women's and Children's Hospital, North Adelaide, SA, Australia
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Shih ML, Duh QY, Hsieh CB, Liu YC, Lu CH, Wong CS, Yu JC, Yeh CC. Bilateral superficial cervical plexus block combined with general anesthesia administered in thyroid operations. World J Surg 2011; 34:2338-43. [PMID: 20623224 PMCID: PMC2939771 DOI: 10.1007/s00268-010-0698-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background We investigated the analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy and to determine whether it reduces the adverse effects of general anesthesia. Methods We prospectively recruited 162 patients who underwent elective thyroid operations from March 2006 to October 2007. They were randomly assigned to receive a bilateral superficial cervical block (12 ml per side) with isotonic saline (group A; n = 56), bupivacaine 0.5% (group B; n = 52), or levobupivacaine 0.5% (group C; n = 54) after induction of general anesthesia. The analgesic efficacy of the block was assessed with: intraoperative anesthetics (desflurane), numbers of patients needing postoperative analgesics, the time to the first analgesics required, and pain intensity by visual analog scale (VAS). Postoperative nausea and vomiting (PONV) for 24 h were also assessed by the “PONV grade.” We also compared hospital stay, operative time, and discomfort in swallowing. Results There were no significant differences in patient characteristics. Each average end-tidal desflurane concentration was 5.8, 3.9, and 3.8% in groups A, B, and C, respectively (p < 0.001). Fewer patients in groups B and C required analgesics (A: B: C = 33:8:7; p < 0.001), and it took longer before the first analgesic dose was needed postoperatively (group A: B: C = 82.1:360.8:410.1 min; p < 0.001). Postoperative pain VAS were lower in groups B and C for the first 24 h postoperatively (p < 0.001). Incidences of overall and severe PONV were lower, however, there were not sufficient numbers of patients to detect differences in PONV among the three groups. Hospital stay was shorter in group B and group C (p = 0.011). There was no significant difference in operative time and postoperative swallowing pain among the three groups. Conclusions Bilateral superficial cervical plexus block reduces general anesthetics required during thyroidectomy. It also significantly lowers the severity of postoperative pain during the first 24 h and shortens the hospital stay.
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Affiliation(s)
- Ming-Lang Shih
- Division of General Surgery, Department of Surgery, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
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