Wound infiltration with bupivacaine 0.5% with or without adrenaline does not decrease pain after thyroidectomy. A randomized controlled study

Post-thyroidectomy pain relief is enhanced by wound infiltration. A systematic review of randomized controlled trials

INTRODUCTION

Thyroidectomy is a common surgical procedure. Traditional options for pain management, such as analgesics and nonsteroidal anti-inflammatory medications (NSAIDs), are limited by their side effects. Surgical wound infiltration with local anesthetics has the potential to reduce the need for analgesics in a number of surgical procedures. This systematic review and meta-analysis wanted to resolve these concerns and assess the efficacy of WI in the management of postoperative pain after thyroidectomy.

MATERIAL AND METHODS

The review adhered to Cochrane Collaboration and PRISMA standards. RCTs comparing WI with no infiltration or placebo were included. Patients with benign or malignant thyroid disease who underwent open thyroidectomy were eligible. Postoperative pain was assessed using a visual analogue scale (VAS) as the primary outcome. Time to first rescue dose, the need for analgesic rescue in the first 24 h, and total opioid analgesic consumption were secondary outcomes. Standardized mean difference (SMD) and odds ratio (OR) were used to analyze the data.

RESULTS

16 randomized controlled trials involving 1202 patients were included. At 6 and 8 h postoperatively, WI exhibited a statistically significant impact on pain management. In the WI group, the need for analgesic rescue was significantly reduced. At 4 h postoperatively, non-anesthetic medications demonstrated a significant analgesic effect.

CONCLUSIONS

This systematic review and meta-analysis support the use of WI with local anesthetics for postoperative pain management after thyroidectomy. These findings have significant implications for improving perioperative care, especially in ambulatory settings where effective pain management is essential.

Local Wound Infiltration for Thyroidectomized Patients in the Era of Multimodal Analgesia

The first few hours following thyroidectomy are the most crucial for pain management. Adequate postoperative pain control, reduction in opioid abuse and the possibility of implementing one-day operations are the considered parameters when developing the postoperative analgesic strategy. A study of the available literature was conducted, exploring the efficacy of (open) thyroidectomy wound infiltration. Seventeen full-text RCTs were extracted. Local anesthetics and non-steroidal anti-inflammatory drugs were infiltrated. Emphasis was given to postoperative pain scores and requirements for rescue analgesia with opioids. Most authors agree that local wound infiltration for thyroidectomized patients is effective in the management of postoperative pain parameters. In the era of multimodal analgesia, thyroidectomy wound infiltration could represent an essential adjunct contributing to lower VAS scores and reduced opioid requirements.

Perioperative pain management for thyroid and parathyroid surgery: A systematic review

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.

The effect of bupivacaine on postoperative pain following thyroidectomy: a systematic review and meta-analysis

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.

The analgesic efficacy of bilateral superficial cervical plexus block for thyroid surgery under general anesthesia: a prospective cohort study

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.

Multimodal analgesia with ropivacaine wound infiltration and intravenous flurbiprofen axetil provides enhanced analgesic effects after radical thyroidectomy: a randomized controlled trial

BACKGROUND

Thyroidectomy is a common procedure that causes mild trauma. Nevertheless, postoperative pain remains a major challenge in patient care. Multimodal analgesia comprising a combination of analgesics and analgesic techniques has become increasingly popular for the control of postoperative pain. The present study tested the hypothesis that multimodal analgesia with combined ropivacaine wound infiltration and intravenous flurbiprofen axetil after radical thyroidectomy provided better analgesia than a single dosage of tramadol.

METHODS

This randomized controlled trial was conducted in a tertiary hospital. Forty-four patients (age, 18-75 years; American Society of Anesthesiologists status I or II; BMI < 32 kg/m²) scheduled for radical thyroidectomy were randomly assigned to a multimodal analgesia group (Group M) or a control group (Group C) by random numbers assignments, and 40 patients completed the study. All participants and the nurse in charge of follow-up observations were blinded to group assignment. Anesthesia was induced with sufentanil, propofol, and cisatracurium. After tracheal intubation, Group M received pre-incision wound infiltration with 5 ml of 0.5% ropivacaine mixed with epinephrine at 1:200,000 (5 μg/ml); Group C received no wound infiltration. Anesthesia was maintained with target-controlled infusion of propofol, remifentanil, sevoflurane, and intermittent cisatracurium. Twenty minutes before the end of surgery, Group M received 100 mg flurbiprofen axetil while Group C received 100 mg tramadol. Postoperative pain was evaluated with the numerical rating scale (NRS) pain score. Remifentanil consumption, heart rate, and noninvasive blood pressure were recorded intraoperatively. Adverse events were documented. The primary outcome was analgesic effect according to NRS scores.

RESULTS

NRS scores at rest were significantly lower in Group M than in Group C before discharge from the postoperative anesthetic care unit (P = 0.003) and at 2 (P = 0.008), 4 (P = 0.020), and 8 h (P = 0.016) postoperatively. Group M also had significantly lower NRS scores during coughing/swallowing at 5 min after extubation (P = 0.017), before discharge from the postoperative anesthetic care unit (P = 0.001), and at 2 (P = 0.002) and 4 h (P = 0.013) postoperatively. Compared with Group C, NRS scores were significantly lower throughout the first 24 h postoperatively in Group M at rest (P = 0.008) and during coughing/swallowing (P = 0.003). No serious adverse events were observed in either group.

CONCLUSION

Multimodal analgesia with ropivacaine wound infiltration and intravenous flurbiprofen axetil provided better analgesia than tramadol after radical thyroidectomy.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (registration number # ChiCTR1800020290 ; date of registration: 22/12/2018).