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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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Admiraal M, Marhofer P, Hopkins PM, Hollmann MW. Peripheral regional anaesthesia and outcomes: a narrative review of the literature from 2013 to 2023. Br J Anaesth 2024; 132:1082-1096. [PMID: 37957079 PMCID: PMC11103102 DOI: 10.1016/j.bja.2023.10.013] [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: 08/20/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 11/15/2023] Open
Abstract
The use of peripheral regional anaesthesia continues to increase, yet the evidence supporting its use and impact on relevant outcomes often lacks scientific rigour, especially when considering the use of specific blocks for a particular surgical indication. In this narrative review, we consider the relevant literature in a 10-yr period from 2013. We performed a literature search (MEDLINE and EMBASE) for articles reporting randomised controlled trials and other comparative trials of peripheral regional anaesthetic blocks vs systemic analgesia in adult patients undergoing surgery. We evaluated measures of effective treatment and complications. A total of 128 studies met our inclusion criteria. There remains variability in the technical conduct of blocks and the outcomes used to evaluate them. There is a considerable body of evidence to support the use of interscalene blocks for shoulder surgery. Saphenous nerve (motor-sparing) blocks provide satisfactory analgesia after knee surgery and are preferred to femoral nerve blocks which are associated with falls when patients are mobilised early as part of enhanced recovery programmes. There are additional surgical indications where the efficacy of cervical plexus, intercostal nerve, and ilioinguinal/iliohypogastric nerve blocks have been demonstrated. In the past 10 yr, there has been a consolidation of the evidence indicating benefit of peripheral nerve blocks for specific indications. There remains great scope for rigorous, multicentre, randomised controlled trials of many peripheral nerve blocks. These would benefit from an agreed set of patient-centred outcomes.
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Affiliation(s)
- Manouk Admiraal
- Department of Anaesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Peter Marhofer
- Department of Anaesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria.
| | - Philip M Hopkins
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Kamel AAF, Fahmy AM, Fathi HM, Elmesallamy WAEA, Khalifa OYA. Regional analgesia using ultrasound-guided intermediate cervical plexus block versus cervical erector spinae block for anterior cervical spine surgery: a randomized trial. BMC Anesthesiol 2024; 24:153. [PMID: 38649826 PMCID: PMC11034160 DOI: 10.1186/s12871-024-02533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Regional analgesia techniques are crucial for pain management after cervical spine surgeries. Anesthesiologists strive to select the most effective and least hazardous regional analgesia technique for the cervical region. Our hypothesis is that an intermediate cervical plexus (IC) block can provide adequate postoperative analgesia compared to a cervical erector spinae (ES) block in patients undergoing anterior cervical spine surgery. METHODS In this double-blind prospective trial, 58 patients were randomly assigned into two equal groups prior to the administration of general anesthesia. Patients in the IC group (n = 29) underwent ultrasound-guided bilateral intermediate cervical plexus block with 15 ml of bupivacaine 0.25% administered to each side. The ES group (n = 29) underwent ultrasound-guided bilateral cervical erector spinae plane blocks with 15 ml of 0.25% bupivacaine administered to each side at the C6 level. The primary outcome was to record the time to the first call for rescue analgesia (nalbuphine), and the secondary outcomes were to measure the performance time, the onset of the sensory block, the intraoperative fentanyl consumption, postoperative pain intensity using VAS, the postoperative total nalbuphine consumption, and postoperative complications such as nausea, vomiting, hypotension, and bradycardia. RESULTS The performance and onset of sensory block times were significantly shorter in the IC group compared to the ES group. The time to first call for nalbuphine was significantly shorter in the IC group (7.31 ± 1.34 h) compared to the ES group (11.10 ± 1.82 h). The mean postoperative VAS scores were comparable between the two groups at the measured time points, except at 8 h, where it was significantly higher in the IC group, and at 12 h, where it was significantly higher in the ES group. The total nalbuphine consumption was significantly higher in the IC group (33.1 ± 10.13 mg) compared to the ES group (22.76 ± 8.62 mg). CONCLUSIONS For patients undergoing anterior cervical spine surgery, the intermediate cervical plexus block does not provide better postoperative regional analgesia compared to the cervical erector spinae block. Performance time and onset time were shorter in the IC group, whereas nalbuphine consumption was lower in the ES group. TRIAL REGISTRATION The trial was registered at clinicaltrials.gov. (NCT05577559, and the date of registration: 13-10-2022).
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Affiliation(s)
- Alshaimaa Abdel Fattah Kamel
- Anaesthesia, Intensive Care and Pain Management Department, Faculty of Human Medicine, Zagazig University, Alsharkia, Egypt.
- Anesthesia, Intensive Care and Pain Management Department, Faculty of Medicine, Zagazig University, Algamaa Street, Alsharkia, Egypt.
| | - Ahmed M Fahmy
- Anaesthesia, Intensive Care and Pain Management Department, Faculty of Human Medicine, Zagazig University, Alsharkia, Egypt
| | - Heba M Fathi
- Anesthesia, Intensive Care and Pain Management Department, Faculty of Medicine, Zagazig University, Algamaa Street, Alsharkia, Egypt
| | | | - Osama Yehia A Khalifa
- Anaesthesia, Intensive Care and Pain Management Department, Faculty of Human Medicine, Zagazig University, Alsharkia, Egypt
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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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Jain N, Mathur PR, Lakhina K, Patodi V, Jain K, Garg D. A comparison of efficacy of parenteral and perineural dexmedetomidine with 0.25% ropivacaine for post-thyroidectomy analgesia using bilateral superficial cervical plexus block. J Anaesthesiol Clin Pharmacol 2023; 39:98-105. [PMID: 37250248 PMCID: PMC10220179 DOI: 10.4103/joacp.joacp_177_21] [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: 04/11/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 03/21/2023] Open
Abstract
Background and Aims Opioids are conventionally used for post-thyroidectomy pain, regional anesthesia is becoming popular due to its feasibility and efficacy in minimizing use of opioids and hence its side effects. This study compared analgesic efficacy of bilateral superficial cervical plexus block (BSCPB) using perineural and parenteral dexmedetomidine with 0.25% ropivacaine in thyroidectomy patients. Material and Methods In this double-blind study, 60 American Society of Anesthesiologists (ASA) physical status I and II thyroidectomy patients, aged 18-65 years were randomized into two groups. Group A (n = 30) received BSCPB with 0.25% ropivacaine, 10 mL on each side with dexmedetomidine 0.5 μg/kg IV infusion. Group B (n = 30) received 0.25% ropivacaine plus dexmedetomidine 0.5 μg/kg, ten mL on each side. Duration of analgesia by measuring pain visual analog scores (VAS), total dose of analgesic requirement, Haemodynamics parameters and adverse events were recorded for 24 h. Categorical variables were analyzed using Chi-square test and continuous variables were computed as mean with standard deviation and analyzed using independent sample t-test. Mann-Whitney U test was used for analysis of ordinal variables. Results Time to rescue analgesia was longer in Group B (18.6 ± 3.27 h) as compared to Group A (10.2 ± 2.11 h) (P < 0.001). Total analgesic dose required was also found to be lesser in Group B (50.83 ± 20.37 mg) as compared to Group A (73.33 ± 18.27 mg) (P < 0.001). No significant hemodynamic changes or side effects were observed in both groups; (P > 0.05). Conclusion Perineural dexmedetomidine with ropivacaine in BSCPB significantly prolonged the duration of analgesia with reduced rescue analgesic requirement.
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Affiliation(s)
- Neena Jain
- Department of Anesthesiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
| | - Pooja R. Mathur
- Department of Anesthesiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
| | - Kriti Lakhina
- Department of Anesthesiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
| | - Veena Patodi
- Department of Anesthesiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
| | - Kavita Jain
- Department of Anesthesiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
| | - Deepak Garg
- Department of Anesthesiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
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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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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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Jeong HW, Yi J, Lee S, Park S, Kang KN, Lee J, Cho HR, Kim YU. Prognostic value of cervical ligamentum flavum thickness as a morphological parameter to predict cervical stenosis. Medicine (Baltimore) 2021; 100:e27084. [PMID: 34449510 PMCID: PMC8389973 DOI: 10.1097/md.0000000000027084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/12/2021] [Indexed: 01/04/2023] Open
Abstract
One of major causes of cervical central stenosis (CCS) is thickened change of cervical ligament flavum (CLF). The association of a morphological parameter called cervical ligament flavum thickness (CLFT) with CCS has not been reported yet. Thus, the purpose of this research was to investigate the relationship between CCS and CFJT.Data were obtained from 88 patients with CCS. A total of 87 normal controls also underwent cervical spine magnetic resonance imaging (CSMRI). All subjects underwent axial T2-weighted CSMRI. Using our picture archiving and communications system, thickness of ligament flavum of the cervical spine at C6/7 level was analyzed.The mean CLFT was 1.41 ± 0.24 mm in normal subjects and 2.09 ± 0.39 mm in patients with CCS. The CCS group was found to have significantly (P < .001) higher rate of CLFT than normal subjects. ROC curves were used to assess the usefulness of CLFT as a predictor of CCS. In the CCS group, the best practical cut off-point of CLFT was 1.71 mm (sensitivity = 90.9%; specificity = 90.8%), with AUC of 0.94 (95% confidence interval: 0.90--0.98).Greater CLFT values were associated with greater possibility of CCS. Thus, treating physician should carefully examine CLFT, as it can help diagnose CCS.
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Affiliation(s)
- Hye-Won Jeong
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Sooho Lee
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Sukhee Park
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Jonghyuk Lee
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Hyung Rae Cho
- Department of Anesthesiology and Pain Medine, Myongji Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
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An SJ, Hong SJ, Kim YU, Lee YK. Best cut-off point of the cervical facet joint area as a new morphological measurement tool to predict cervical foraminal stenosis. J Pain Res 2019; 12:1325-1330. [PMID: 31114310 PMCID: PMC6497142 DOI: 10.2147/jpr.s204567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/06/2019] [Indexed: 01/18/2023] Open
Abstract
Purpose: One of the main factor of cervical foraminal stenosis (CFS) is the hypertrophic change of the cervical facet joint. In order to analyze the connection between CFS and the facet joint hypertrophy, we devised a new morphological parameter, called the cervical facet joint cross-sectional area (CFJA). The CFJA has not yet been investigated for its association with CFS. We hypothesized that the CFJA is an important morphologic parameter in the diagnosis of CFS. Patients and methods: All patients over 50 years of age were included. Data regarding the CFJA were collected from 160 subjects with CFS. A total of 162 control individuals underwent cervical spine magnetic resonance imaging (CMRI) as part of a routine medical examination. Axial T2-weighted CMRI images were acquired from all subjects. We used a picture archiving system to analyze the cross-sectional area of the bone margin of the cervical facet joint at the level of the most stenotic cervical spine in the axial plane. Results: The average CFJA was 109.07±20.91 mm2 in the control group, and 126.75±22.59 mm2 in the CFS group. The CFS group was found to have significantly higher levels of the CFJA (p<0.001) than the control group. ROC curve estimation was used to verify the validity of the CFJA as a new predictor of CFS. In the CFS group, the best cut off-point was 113.14 mm2, with sensitivity =70.6%, specificity =68.6%, and AUC =0.72 (95% CI, 0.66–0.77). Conclusions: CFJA high values were closely associated with a possibility of CFS. We concluded CFJA is easy to use, fast, and useful new morphological parameter to predict CFS.
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Affiliation(s)
- Sang Joon An
- Department of Neurology, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Seok Jun Hong
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University, College of Medicine, Seoul, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Yoon Kyung Lee
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University, College of Medicine, Seoul, Republic of Korea
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Goulart TF, de Araujo-Filho VJF, Cernea CR, Matos LL. Superficial cervical plexus blockade improves pain control after thyroidectomy: A randomized controlled trial. Clinics (Sao Paulo) 2019; 74:e605. [PMID: 31531572 PMCID: PMC6735272 DOI: 10.6061/clinics/2019/e605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/24/2019] [Indexed: 11/29/2022] Open
Abstract
OJECTIVES The aim was to evaluate the ability of bilateral superficial cervical plexus blockade to control pain and to reduce the side effects of general anesthesia in patients submitted to thyroidectomy. METHODS In this randomized controlled trial, we prospectively studied 100 consecutive patients who underwent total thyroidectomy. The simple random patient sample was divided into two groups: 50 patients received general anesthesia alone (group 1 [G1]), and 50 patients received general anesthesia with bilateral superficial cervical plexus blockade (group 2 [G2]). Statistical analyses were performed, and a 5% significance level was adopted. RESULTS The mean arterial blood pressure and heart rate were 12% lower in G2 patients than in G1 patients 60 minutes after surgery (101 mmHg for G1 vs. 92.3 mmHg for G2; p<0.001). G2 patients reported less pain than G1 patients, and opioid consumption was lower in G2 patients than in G1 patients, not upon postanesthesia care unit arrival, but at 30 minutes (2% vs. 34%; p<0.001, respectively), 45 minutes (0% vs. 16%; p=0.006, respectively), and 4 hours postoperatively (6% vs. 20%; p=0.037, respectively). The incidence of nausea and vomiting was lower in G2 patients than in G1 patients from 45 minutes (0% vs. 16%; p=0.006, respectively) to 8 hours postoperatively (0% vs. 14%; p=0.012, respectively). CONCLUSIONS The present study demonstrated that the combination of bilateral superficial cervical plexus blockade with general anesthesia for thyroidectomy is feasible, safe, and effective for achieving pain control and improving patient outcomes.
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Affiliation(s)
- Taís Fonseca Goulart
- Departamento de Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding authors. E-mail:
| | - Vergilius José Furtado de Araujo-Filho
- Departamento de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding authors. E-mail:
| | - Claudio Roberto Cernea
- Departamento de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Leandro Luongo Matos
- Departamento de Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding authors. E-mail:
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Kim JS, Ko JS, Bang S, Kim H, Lee SY. Cervical plexus block. Korean J Anesthesiol 2018; 71:274-288. [PMID: 29969890 PMCID: PMC6078883 DOI: 10.4097/kja.d.18.00143] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/24/2018] [Indexed: 12/14/2022] Open
Abstract
Cervical plexus blocks (CPBs) have been used in various head and neck surgeries to provide adequate anesthesia and/or analgesia; however, the block is performed in a narrow space in the region of the neck that contains many sensitive structures, multiple fascial layers, and complicated innervation. Since the intermediate CPB was introduced in addition to superficial and deep CPBs in 2004, there has been some confusion regarding the nomenclature and definition of CPBs, particularly the intermediate CPB. Additionally, as the role of ultrasound in the head and neck region has expanded, CPBs can be performed more safely and accurately under ultrasound guidance. In this review, the authors will describe the methods, including ultrasound-guided techniques, and clinical applications of conventional deep and superficial CPBs; in addition, the authors will discuss the controversial issues regarding intermediate CPBs, including nomenclature and associated potential adverse effects that may often be neglected, focusing on the anatomy of the cervical fascial layers and cervical plexus. Finally, the authors will attempt to refine the classification of CPB methods based on the target compartments, which can be easily identified under ultrasound guidance, with consideration of the effects of each method of CPB.
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Affiliation(s)
- Jin-Soo Kim
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Justin Sangwook Ko
- Depatment of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine,, Seoul, Korea
| | - Seunguk Bang
- Depatment of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyungtae Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Sook Young Lee
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
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