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

Ketamine infiltration improves analgesia after thyroid surgery

Background: Postoperative pain increases the risk of postoperative complications and may predispose patients to chronic post-surgical pain. This study aims to evaluate the impact of ketamine wound infiltration versus placebo at the end of thyroid surgery on postoperative pain and analgesic requirements. Methods: In this randomized controlled trial, we prospectively studied patients who underwent thyroid surgery. Patients were randomized into two groups: group S, where local infiltration was performed using 10 ml of a physiological saline solution; and group K, where 10 ml of a solution containing 2 mg/kg ketamine was infiltrated. Standardized thyroidectomies were performed in the 2 groups. Pain perception was measured using a visual analog scale (VAS) every 10 minutes in the post-anesthetic care unit (PACU) for 2 hours and thereafter every 6 hours during the first 24 hours. The opioid requirement in the PACU was evaluated. A comparison between the 2 groups was carried out. Results: Postoperatively, the mean VAS was higher in group S compared to group K during all PACU stay periods and the first 24 hours. Pain scores during swallowing were significantly lower for group K in the PACU at 0, 10, and 20 minutes. The mean morphine consumption in the PACU was 0.71 mg and 0 mg respectively in group S and group K (p=0.03). The incidence of nausea and vomiting was similar in both groups. Conclusions: Ketamine wound infiltration is an efficient modality to reduce postoperative opioid consumption compared to a placebo after thyroid surgery.

[Thyroidectomy performed under local anesthesia at the University Hospital of Antananarivo]

Menée le plus souvent sous anesthésie générale, la chirurgie thyroïdienne peut aussi être pratiquée sous anesthésie régionale ou sous anesthésie locale. Notre objectif a été de rapporter l'expérience du Centre Hospitalier Universitaire d'Antananarivo sur l'anesthésie locale dans les thyroïdectomies. La drogue employée dans notre protocole anesthésique a été le fentanyl, administré en intraveineuse directe, associé à une infiltration sous-cutanée de lidocaïne suivant la ligne d'incision. Le/la patient(e) n'a pas été intubé(e), l'oxygène étant délivré au niveau des cavités nasales. Ont été étudiés le type de chirurgie thyroïdienne, la durée de l'intervention, la satisfaction des patient(e)s vis-à-vis de la qualité de l'anesthésie, et le coût de l'intervention. Sur 567 thyroïdectomies effectuées, 51,68% (n= 293) ont été des lobo-isthmectomies gauches, 44,44% (n= 252) des lobo-isthmectomies droites, 2,82% (n= 16) des thyroïdectomies subtotales ou totales, 1,06% (n= six) des totalisations pour carcinomes thyroïdiens. La durée des interventions a varié de 30 à 90 minutes. Un total de 83,95% (n= 476) des patient(e)s a été très satisfait de la qualité de l'anesthésie et 15,87% autres (n= 90) satisfait. Les suites opératoires ont été bonnes dans la majorité des cas. Le coût d'une thyroïdectomie a été évalué à 100- 150 dollars américains. L'anesthésie locale utilisée dans les thyroïdectomies effectuées au Centre Hospitalier Universitaire d'Antananarivo est simple, rapide, d'un coût moyen, et permet d'alarmer précocement le chirurgien en cas de lésion d'un nerf laryngé inférieur.

Surgical treatment of endemic goiter in a nonhospital setting without general anesthesia in Africa

BACKGROUND

Endemic goiter remains a serious public health problem and 75 % of people affected live in underdeveloped countries where treatment is difficult for various reasons. The aim of this article is to report our experience in African countries with the management and surgical treatment of endemic goiter, performed in a nonhospital setting and without general anesthesia in the context of a collaborative development project by experienced endocrine surgeons.

METHODS

Fifty-six black African patients with a goiter were studied. Those in poor general health, the elderly, patients with either small goiters or clinical hyperthyroidism, and those presenting with an acute episode of malaria were excluded from the study. Cervical epidural anesthesia with spontaneous ventilation was used and a partial thyroidectomy was performed. The technique used, its immediate complications, and early and late follow-up were analyzed.

RESULTS

Surgery was performed on 31 patients with grades 3 and 4 goiter without mortality and a morbidity rate of 11.9 %, with 97 % of all complications being minor. There were no instances of dysphonia or symptomatic hypocalcemia and the mean stay was 1.57 days (range 1.25-1.93). Follow-up in the first year was 71 % and no case of severe or recurrent hypothyroidism was detected.

CONCLUSIONS

Surgery without general anesthesia performed in a nonhospital setting in underdeveloped countries in patients with goiter is a viable option with good results and low morbidity.