Article

Bilateral Superficial Cervical Plexus Block Reduces Postoperative Nausea and Vomiting and Early Postoperative Pain after Thyroidectomy

Department of Anaesthesiology, First Affiliated Hospital of Fujian Medical University, Fujian, China
The Journal of international medical research (Impact Factor: 1.44). 08/2012; 40(4):1390-8. DOI: 10.1177/147323001204000417
Source: PubMed

ABSTRACT

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).
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.
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.
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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    • "Some studies have shown a significant decrease in postthyroidectomy pain scores and analgesia requirements after BSCB whereas a few others reported that VAS scores and total patient controlled analgesia doses were comparable among groups of patients receiving or not receiving bilateral SCB [8][9][10]. The exact reason for the high incidence of postoperative nausea and vomiting in the BSCP block group in our study is difficult to explain and is contrary to some previous observations [13]. Emesis has multifactorial causation and it could not necessarily be correlated with a particular kind of block. "
    [Show abstract] [Hide abstract] ABSTRACT: The aim of the current study was to investigate the efficacy of greater occipital nerve (GON) block and bilateral superficial cervical plexuses (BSCP) blocks in alleviating postoperative occipital headache and posterior neck pain after thyroidectomy. This randomized prospective study consisted of 75 women undergoing total thyroidectomy. Patients were randomized into three groups: Group I ( n = 25 ): patients receiving GON, Group II ( n = 25 ): patients receiving bilateral (BSCP) blocks, and Group III ( n = 25 ): patients receiving no block. Assessment of occipital headache, posterior neck, and incision site pains was made at 12 hours and 24 hours after extubation by Visual Analogue Scale (VAS). In comparison to Group III significantly fewer patients in Groups I and II experienced occipital headache at 12 ( p = 0.006 ) and 24 hours ( p = 0.005 ) and also posterior neck pain at 24 hours ( p = 0.003 ). Mean VAS scores at 12 and 24 hours for occipital headache ( p = 0.003 and p = 0.041 ) and posterior neck pain ( p = 0.015 and p = 0.008 ) were significantly lower in Group I. The differences between Groups II and III were not significant except for the occipital headache at 12 hours. The efficacy of GON block is superior to BSCP blocks in alleviating postthyroidectomy occipital headache and posterior cervical pain.
    Full-text · Article · Mar 2016 · Journal of Thyroid Research
  • [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).
    No preview · Article · Dec 2013 · British Journal of Surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Bilateral superficial cervical plexus block is a simple non-invasive technique that can be used as preventive analgesia in the perioperative period of thyroidectomy. Aim: to assess the analgesic effects of the technique during the postoperative period of thyroidectomy. Material and Methods: Patients with indication of total thyroidectomy, with a low operative risk according to the American Society of Anesthesiology, were studied. All were operated with general anesthesia using Fentanyl, Propofol, Vecuronium and Isoflurane. Patients were randomly and blindly assigned to superficial cervical plexus block using Bupivacaine 0.25% or to a placebo injection. Postoperative pain, need for analgesics and patient satisfaction were assessed.
    No preview · Article · Jan 2014 · Revista Chilena de Cirugia
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