Article

Comparison of analgesic efficacy between bilateral superficial and combined (superficial and deep) cervical plexus block administered before thyroid surgery

Department of General Surgery, Saint Vincent Hospital, The Catholic University of Korea, Suwon, Korea.
European Journal of Anaesthesiology (Impact Factor: 2.79). 07/2009; 26(12):1043-7. DOI: 10.1097/EJA.0b013e32832d6913
Source: PubMed

ABSTRACT To evaluate the analgesic efficacy of bilateral superficial cervical plexus block and combined superficial and deep cervical plexus block for incision pain, headache and posterior neck pain after thyroidectomy.
Ninety patients were divided into a control group (group C, n = 30), a bilateral superficial cervical plexus group (group S, n = 30) and a bilateral combined superficial and deep cervical plexus block group (group CO, n = 30). Before general anaesthesia, we performed bilateral superficial cervical plexus block (18 ml) and combined superficial (14 ml) and deep (4 ml) cervical plexus block with 0.25% bupivacaine. Anaesthesia was maintained with propofol-remifentanil-N2O-O2.
The average concentration of remifentanil was significantly reduced in group S compared with group C and group CO (1.1 +/- 0.3, 1.8 +/- 0.4, 1.8 +/- 0.7 ng ml, respectively; P < 0.05). The incision pain at rest and on swallowing were significantly reduced at 0, 2 and 4 h in group S compared with group C (P < 0.05). Headache showed a tendency to be reduced in group S and group CO, but the posterior neck pain was not different among the three groups. After surgery, the opioid and nonopioid requirement was significantly reduced in group S (P < 0.05). There were fewer side effects and greater patients' satisfaction in group S.
Superficial cervical plexus block is a more effective technique than combined superficial and deep cervical plexus block to reduce the pain during and immediately after thyroidectomy.

0 Bookmarks
 · 
92 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT Objective: To evaluate the effect of bilateral superficial cervical plexus block (BSCPB) applied in addition to general anesthesia on postoperative opioid consumption and length of hospital stay in patients having total thyroidectomy. Material and Methods: A total of 97 patients who underwent total thyroidectomy under general anesthesia between January and June 2010, who had or did not havebilateral superficial cervical plexus block (BSCPB) were retrospectively evaluated in terms of postoperative tramadol requirement and length of hospital stay. Of these patients, 24 were excluded for various reasons. Of the remaining 73 patients, 33 patients who underwent BSCPB with 0.5% 20 ml levobupivacaine at the beginning of surgery after anesthesia induction were evaluated as BSCPB group; remaining 40 patients were evaluated as the control group. Results: A statistically significant difference could not be found when age, gender, height, weight, ASA (American Society of Anesthesiologists) physical status classification and education level of the patients were compared between two groups. While 11 (33%) of 33 patients in the BSCPB group needed postoperative opioids, 36 (90%) of 40 patients in the control group needed postoperative opioids (p<0.001). Tramadol consumption was found significantly lower in BSCPB group compared to the control group (p<0.001). When the length of hospital stay in postoperative period was compared, it was found statistically significantly shırter in BSCPB group (2.18±0.88 days) compared to the control group (2.78±1.38 days) (p=0.037). Conclusion: We consider that bilateral superficial cervical plexus block performed in addition to general anesthesia in thyroidectomy operations reduces tramadol requirement in the postoperative period as well as the length of hospital stay.
    Turkiye Klinikleri Journal of Medical Sciences 04/2012; 32(2):394-398. DOI:10.5336/medsci.2011-23996 · 0.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We report a case of partial thyroidectomy under ultrasound-guided regional anesthesia, according a new anterior approach, in a patient with a severe primitive pulmonary hypertension.
    Annales francaises d'anesthesie et de reanimation 08/2013; 32(10). DOI:10.1016/j.annfar.2013.07.800 · 0.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: 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. 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. 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). 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).
    British Journal of Surgery 12/2013; 100(13):1732-8. DOI:10.1002/bjs.9292 · 4.84 Impact Factor