ArticlePDF Available

Blok Pleksus Servikal Superfisialis sebagai Analgetik Adjuvan pada Operasi Tiroidektomi: Sebuah Laporan Kasus

Authors:
Albertus Medianto Walujo at Udayana University
Albertus Medianto Walujo
I Gde Agus Shuarsedana Putra
I Gde Agus Shuarsedana Putra
I Gde Agus Shuarsedana Putra
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Nova Juwita
Nova Juwita
Nova Juwita
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Download full-text PDF
Read full-text
Download citation

Abstract

Pendahuluan: Berbagai macam teknik anestesi regional sudah banyak dikembangkan guna memfasilitasi pengendalian nyeri selama operasi maupun paska operasi, blok pleksus servikalis superfisialis (BPSS) merupakan salah satunya. Penulis mempresentasikan kasus, pasien laki-laki berusia 53 tahun yang menjalankan operasi tiroidektomi. Dilakukan anestesi umum pada pasien dengan adjuvan BPSS guna mengendalikan nyeri intra maupun paska operasi. Dari laporan kasus ini dapat disimpulkan bahwa BPSS adalah teknik anestesi regional yang mudah aplikasikan dan secara efektif dapat menjadi adjuvant pada pembedahan tiroidektomi serta dapat mengurangi penggunaan opioid selama operasi.Ilustrasi Kasus: Pada laporan kasus ini, dilakukan pengamatan pada pasien laki-laki berusia 53 Ilustrasingan keluhan benjolan pada leher sejak 1 bulan yang lalu, yang menjalani pembedahan tiroidektomi. Pasien mendapatkan premedikasi dan setelah prosedur intubasi, dilakukan blok pleksus servikalis superfisialis dengan menggunakan ropivakain 0.75% sebanyak 10 cc dengan teknik mengipas dan anestesi lokal diberikan sepanjang batas posterior muskulus sternokleidomastoideus. Selama operasi berlangung, tanda-tanda vital dalam batas normal. Simpulan: Blok pleksus servikalis superfisialis adalah teknik anestesi regional yang mudah aplikasikan dan secara efektif dapat menjadi adjuvant pada pembedahan tiroidektomi serta dapat mengurangi penggunaan opioid selama operasi.
Available via license: CC BY-NC 4.0
Content may be subject to copyright.
Blok Pleksus Servikal Supersialis Sebagai Analgek Adjuvan pada
Operasi Tiroidektomi: Sebuah Laporan Kasus
Albertus Medianto Walujo1*, I Gde Agus Shuarsedana Putra2, Nova Juwita2
1. Departemen Anestesiologi dan Terapi Intensif Rumah Sakit Umum Daerah Wangaya
2. Residen Anestesiologi Dan Reanimasi, Fakultas Kedokteran, Universitas Udayana-RSUP
Sanglah
ABSTRAK
Pendahuluan: Berbagai macam teknik anestesi regional sudah banyak dikembangkan guna
memfasilitasi pengendalian nyeri selama operasi maupun paska operasi, blok pleksus servikalis
supersialis (BPSS) merupakan salah satunya. Penulis mempresentasikan kasus, pasien laki-laki
berusia 53 tahun yang menjalankan operasi roidektomi. Dilakukan anestesi umum pada pasien
dengan adjuvan BPSS guna mengendalikan nyeri intra maupun paska operasi. Dari laporan kasus ini
dapat disimpulkan bahwa BPSS adalah teknik anestesi regional yang mudah aplikasikan dan secara
efekf dapat menjadi adjuvant pada pembedahan roidektomi serta dapat mengurangi penggunaan
opioid selama operasi.
Ilustrasi Kasus: Pada laporan kasus ini, dilakukan pengamatan pada pasien laki-laki berusia 53
Ilustrasingan keluhan benjolan pada leher sejak 1 bulan yang lalu, yang menjalani pembedahan
roidektomi. Pasien mendapatkan premedikasi dan setelah prosedur intubasi, dilakukan blok
pleksus servikalis supersialis dengan menggunakan ropivakain 0.75% sebanyak 10 cc dengan teknik
mengipas dan anestesi lokal diberikan sepanjang batas posterior muskulus sternokleidomastoideus.
Selama operasi berlangung, tanda-tanda vital dalam batas normal.
Simpulan: Blok pleksus servikalis supersialis adalah teknik anestesi regional yang mudah aplikasikan
dan secara efekf dapat menjadi adjuvant pada pembedahan roidektomi serta dapat mengurangi
penggunaan opioid selama operasi.
Kata Kunci: blok pleksus servikal supersialis, analgek adjuvan, roidektomi
PP PERDATIN 108
LAPORAN KASUS
*penulis korespondensi
DOI:10.55497/majanestcricar.v40i2.234
ABSTRACT
Background: The Bonls Intubaon Fibrescope is a rigid opcal instrument for performing orotracheal
Various regional anesthec techniques have been developed to control pain during and aer surgery,
supercial cervical plexus block (SCPB) is one of the techniques that can be used. We present a
case, male paent, 53-years-old who underwent thyroidectomy surgery. General anesthesia was
performed on paents with SCPB adjuvant to control intra- and postoperave pain. From this case
report, it can be concluded that BPSS is a regional anesthec technique that is easy to apply and can
eecvely be an adjuvant in thyroidectomy surgery, and can reduce the use of opioids during surgery.
Case Illustraon: In this case report, an observaon was made on a 53-year-old male paent
complaining of a lump in the neck since 1 month ago, who underwent thyroidectomy surgery. The
paent received premedicaon and aer the intubaon procedure, a supercial cervical plexus block
was performed using 10 cc of 0.75% ropivacaine with a fan technique and local anesthesia was
administered along the posterior border of the sternocleidomastoid muscle. During the operaon,
vital signs were within normal limits.
Conclusion: Supercial cervical plexus block is a regional anesthec technique that is easy to apply
and can eecvely be an adjuvant to thyroidectomy surgery and can reduce the use of opioids during
surgery.
Keywords: supercial cervical plexus block, adjuvant analgesia, thyroidectomy
PP PERDATIN 109
CASE REPORT
*corresponding author
Supercial Cervical Plexus Block as Adjuvant Analgesia In
Thyroidectomy: A Case Report
Albertus Medianto Walujo1*, I Gde Agus Shuarsedana Putra2, Nova Juwita2
1. Departement of Anesthesiology and Intensive Care, Wangaya Hospital
2. Anesthesiology and Reanimaon Residency, Faculty of Medicine, Universitas Udayana-RSUP
Sanglah
DOI:10.55497/majanestcricar.v40i2.234
PP PERDATIN
Walujo AM, dkk.
Berbagai macam teknik anestesi regional sudah
banyak dikembangkan guna memfasilitasi
pengendalian nyeri selama operasi maupun
paska operasi, blok pleksus servikalis supersialis
(BPSS) merupakan salah satunya. Penulis
mencoba memaparkan efektas BPSS sebagai
analgek adjuvant pada operasi roidektomi
guna maneurunkan penggunaan opioid
intraoperasi.
ILUSTRASI KASUS
Pasien laki-laki berusia 53 tahun dengan keluhan
benjolan pada leher sejak 1 bulan yang lalu,
dalam 2 minggu terakhir pasien mengeluh
sulit menelan dan nyeri pada daerah leher sisi
kanan. Pasien dak mengalami gejala hiperroid
seper turunnya berat badan, merasa panas,
berkeringat, sesak napas, dan jantung berdebar.
Pasien menyangkal adanya riwayat penyakit lain
sebelumnya. Pasien adalah perokok akf. Tidak
ada obat run yang diminum oleh pasien.
Pasien memiliki nggi badan 165cm dan berat
badan 75 kg. Pada pemeriksaan sik teraba
sebuah nodul pada regio colli anterior dekstra
ukuran diameter sekitar 2 cm, berbatas tegas,
konsistensi kenyal, dan bergerak saat menelan.
Pasien telah menjalani ndakan FNAB dengan
gambaran sitomorfologi yang mengesankan
suatu nodul koloid.
Pada evaluasi pre anestesi pasien mendapat
penjelasan mengenai prosedur pembiusan
dan pembedahan yang akan dilakukan.
Tanda vital sebelum operasi menunjukkan
tekanan darah 110/70 mmHg, nadi 70x/menit,
respirasi 18x/menit, suhu 36.5oC, SpO2 99%.
Pasien mendapatkan premedikasi intravena
yaitu difenhidramin 10 mg, dual anemek
dexamethasone 10 mg dan ondansetron 8 mg,
serta anbiok prolaksis ceriaxone 1 gr. Pasien
diberikan fentanil 150 mcg sebagai analgek
intubasi. Induksi dilakukan dengan pemberian
propofol 200 mg. Pelemas otot yang diberikan
adalah atracurium 40 mg dan dilakukan intubasi
menggunakan ETT 7.5 dengan videolaringoskopi.
Setelah prosedur intubasi, dilakukan blok
pleksus servikalis supersialis dengan
menggunakan ropivakain 0.75% sebanyak 10
cc dengan teknik mengipas dan anestesi lokal
diberikan sepanjang batas posterior muskulus
sternokleidomastoideus. Pemeliharaan anestesi
menggunakan anestesi inhalasi, Fresh Gas Flow
menggunakan O2 : free air;1.5 : 2 L dengan
anestesi volal sevourane 2 – 2,5 Vol% (MAC
1 – 1,25). Tidak ada penambahan analgek
durante operasi.
Selama operasi berlangung, tanda-tanda vital
dalam batas normal. Operasi berlangsung
selama 2 jam. Selama operasi berlangsung
hemodinamik pasien stabil, uktuasi tanda vital
minimal, dan perdarahan intra operasi sekitar 50
ml.
Setelah selesai operasi dilakukan leak test untuk
memaskan jalan napas pasien aman, kemudian
pasien dilakukan ekstubasi secara sadar dan
pasien masuk ke ruang pemulihan. Selama di
ruang pemulihan kondisi pasien stabil dengan
nyeri paska operasi yang minimal, dengan skor
nyeri NRS 2.
PENDAHULUAN
110
Gambar 1. Landmark pada Pleksus Supersialis Servikalis dan BPSS
PP PERDATIN
MajAnestCriCare Vol. 40 No.2
111
Gambar 2a. Pembedahan Tiroidektomi; 2b.Paska Pembedahan Tiroidektomi
PEMBAHASAN
Banyak teknik anestesi regional yang dikem-
bangkan guna menunjang pengendalian
nyeri selama operasi maupun paska opera-
si, blok pleksus servikalis supersialis (BPSS)
merupakan salah satunya. BPSS dapat mem-
berikan efek analgek yang baik pada pem
bedahan di area yang dipersara saraf C2-
C4. Teknik ini dilakukan dengan memberikan
anestesi lokal pada pleksus servikalis super-
sialis. Pleksus servikalis supersialis memper-
sara kulit leher sisi anterolateral. Cabang
terminal muncul sebagai empat saraf yang
berbeda dari batas posterior otot sternoklei-
domastoideus yaitu nervus oksipitalis mi-
nor, nervus aurikularis mayor, nervus servika-
2a
Gambar 3. Tanda Vital Selama Pembedahan Tiroidektomi
2b
PP PERDATIN
Walujo AM, dkk.
112
lis kutaneus, dan nervus supraklavikularis.1,2
BPSS secara konvensional didenisikan sebagai
injeksi subkutan yang dilakukan pada bagian
tengah dari batas posterior otot sternokleido-
mastoideus. Teknik konvensional inltrasi sub-
kutan ini dapat dilakukan dengan dipandu USG
atau menggunakan landmark. Dibandingkan
dengan blok pleksus servikalis dalam, BPSS me-
miliki komplikasi yang lebih minimal dan lebih
mudah untuk dikerjakan. BPSS unilateral mau-
pun bilateral juga dapat berguna sebagai anal-
gek untuk operasi roidektomi, minimal invasif
pararoidektomi, pembedahan mpanomas-
toid, dan masih banyak pembedahan lainnya.3
Dalam sebuah penelian Egan dkk menyim-
pulkan bahwa BPSS menurunkan skor nyeri
seusai pembedahan roid dan pararoid, dan
mengurangi kebutuhan opioid selama operasi
dan paska operasi. Lebih sedikit pasien dengan
BPSS yang membutuhkan opioid kuat (5 dari 29
pasien vs 16 dari 29 pasien; P=0.003).4 Gürkan
dkk dalam peneliannya menyimpulkan bahwa
BPSS dengan panduan ultrasonogra memberi-
kan efek analgek yang signikan pada pem-
bedahan roid, konsumsi morn paska operasi
lebih rendah pada kelompok BPSS dibandingkan
dengan kelompok kontrol pada jam ke-6, 12,
dan 24 paska operasi (dosis median konsumsi
morn 4, 8, 9mg pada kelompok BPSS dan 5,
9, 11 mg pada kelompok kontrol) (P <0,05).5
Sejak anestesi lokal berdurasi panjang dengan
keamanan obat yang baik diperkenalkan, peng-
gunaan teknik blok saraf perifer meningkat
beberapa dekade belakangan.6 Kami menggu-
nakan ropivakain isobarik sebagai anestesi lokal
yang diberikan pada BPSS karena memiliki tok-
sisitas kardiovaskular yang minimal dan durasi
yang panjang sehingga cocok untuk memberi-
kan efek analgek selama operasi.7 Ropivakain
juga memiliki derajat diferensiasi motorik sen-
sorik yang baik, sehingga cocok digunakan pada
pasien kami yang menjalani operasi di daerah
jalan napas dimana kami dak menginginkan
adanya blok motorik setelah operasi selesai
namun kami membutuhkan blok sensoriknya.8
Ropivakain cenderung kurang lipolik sehingga
kecil kemungkinannya untuk menembus serat
motorik besar bermielin, menghasilkan blokade
motorik yang minimal.9 Leoni dkk dalam studi-
nya memaparkan bahwa ropivakain merupakan
pilihan yang baik pada blok pleksus servikalis,
dalam penelitannya pada subjek yang men-
jalani operasi carod endarterectomy menun-
jukkan ropivakain memberikan durasi analgek
paska operasi yang lebih lama dari mepivakain,
obat nyeri pertama paska operasi setelah 10
(4 - 13) jam dan 9 (6,5 - 11) jam pada ropiv-
akain 0,75% dan 1% dibandingkan setelah 5
(0 - 8) jam pada mepivakain 2% (P <0,05).10
Berdasarkan pengamatan hemodinamik se-
lama pembedahan pasien, BPSS efekf untuk
memberikan efek analgesia yang opmal. Hal
tersebut digambarkan dari tanda vital pasien
yang stabil selama pembedahan berlangsung.
Nyeri pada pembedahan dapat memberi-
kan smulus pada persarafan simpas yang
memberikan gambaran peningkatan tekan-
an darah sistolik dan diastolik, mean arte-
rial blood pressure (MAP), dan nadi pasien.11
Penulis melakukan cu leak test sebelum
melakukan ekstubasi, tes ini ditujukan untuk
memprediksi adanya stridor paska ekstubasi,
namun tes ini dak dapat mengeksklusi ter-
jadinya obstruksi pada struktur supraglok.12
SIMPULAN
Blok pleksus servikalis supersialis adalah teknik
anestesi regional yang mudah aplikasikan dan
secara efekf dapat menjadi adjuvant pada
pembedahan roidektomi serta dapat mengu-
rangi penggunaan opioid selama operasi.
KONFLIK KEPENTINGAN
Tidak ada konik kepenngan.
DAFTAR PUSTAKA
1. Vloka JD, Smeets A-S, Tsai T, Bouts C. Cervical
Plexus Block – Landmarks and Nerve Smu-
lator Technique [Internet]. www.nysora.com.
2017. Available from: hps://www.nysora.
com/techniques/head-and-neck-blocks/cer-
vical/cervical-plexus-block/
2. Hipskind JE, Ahmed AA. Cervical Plexus
Block. In: StatPearls [Internet]. Treasure Is-
land (FL): StatPearls Publishing; 2021 [cited
2021 Jul 20]. Available from: hp://www.
PP PERDATIN
MajAnestCriCare Vol. 40 No.2
113
ncbi.nlm.nih.gov/books/NBK557382/
3. Kim J-S, Ko JS, Bang S, Kim H, Lee SY. Cervi-
cal plexus block. Korean J Anesthesiol. 2018
Aug;71(4):274–88.
4. Egan RJ, Hopkins JC, Beamish AJ, Shah R,
Edwards AG, Morgan JDT. Randomized clini-
cal trial of intraoperave supercial cervical
plexus block versus incisional local anaesthe-
sia in thyroid and parathyroid surgery. Br J
Surg. 2013 Dec;100(13):1732–8.
5. Gürkan Y, Taş Z, Toker K, Solak M. Ultrasound
guided bilateral cervical plexus block reduces
postoperave opioid consumpon following
thyroid surgery. J Clin Monit Comput. 2015
Oct;29(5):579–84.
6. Li A, Wei Z, Liu Y, Shi J, Ding H, Tang H, et
al. Ropivacaine versus levobupivacaine in
peripheral nerve block: A PRISMA-com-
pliant meta-analysis of randomized con-
trolled trials. Medicine (Balmore). 2017
Apr;96(14):e6551.
7. Buerworth JF, Mackey DC, Wasnick JD. Lo-
cal Anesthecs. In: Morgan & Mikhail’s Clini-
cal Anesthesiology. 6th ed. McGraw-Hill Edu-
caon; 2018. p. 261–72.
8. Kuthiala G, Chaudhary G. Ropivacaine: A re-
view of its pharmacology and clinical use. In-
dian J Anaesth. 2011 Mar;55(2):104–10.
9. Kaur A, Singh RB, Tripathi RK, Choubey S.
Comparision between bupivacaine and ropi-
vacaine in paents undergoing forearm sur-
geries under axillary brachial plexus block: a
prospecve randomized study. J Clin Diagn
Res JCDR. 2015 Jan;9(1):UC01-06.
10. Leoni A, Magrin S, Mascoo G, Rigamon A,
Gallioli G, Muzzolon F, et al. Cervical plexus
anesthesia for carod endarterectomy: com-
parison of ropivacaine and mepivacaine. Can
J Anesth Can Anesth. 2000 Feb;47(2):185–7.
11. Asgar Pour H. Associaon Between Acute
Pain and Hemodynamic Parameters in a
Postoperave Surgical Intensive Care Unit.
AORN J. 2017 Jun;105(6):571–8.
12. Nickson C. Cu Leak Test [Internet]. LIFE IN
THE FASTLANE. 2020. Available from: hps://
lil.com/cu-leak-test/
ResearchGate has not been able to resolve any citations for this publication.
Cervical plexus block
Article
Full-text available
  • Jul 2018
Cervical plexus block (CPB) has been used in various head and neck surgeries to provide adequate anesthesia and/or analgesia. However, it is performed in narrow space of neck area containing many sensitive structures, multiple fascial layers, and complicated nerve innervation. Since intermediate CPB was introduced in addition to superficial and deep CPBs in 2004, there has been some confusion in nomenclature and definition of CPB, particularly the intermediate CPB. Additionally, as the role of ultrasound in the head and neck region has expanded, CPB can be performed more safely and accurately under ultrasound guidance. In this review, authors will describe the methods including ultrasound techniques and clinical applications of conventional deep and superficial CPBs, and discuss the controversial issues of intermediate CPB including nomenclature and associated potential adverse effects that may often be neglected, focusing on the anatomy of the cervical fascial layers and cervical plexus. And finally, authors will attempt to refine the classification of CPB methods based on the target compartments which can be easily identified under ultrasound guidance, with considering the effects of each method of CPB.
View
Ropivacaine versus levobupivacaine in peripheral nerve block A PRISMA-compliant meta-analysis of randomized controlled trials
Article
Full-text available
  • Feb 2017
Background To determine which is more potent in peripheral nerve block between ropivacaine and levobupivacaine. Methods A literature search was performed in the EMBASE, Medline, the Cochrane Library, and the Web of Science. The trials that were found were then evaluated for eligibility. The Cochrane Collaboration's Review Manager software was used to perform the meta-analyses. Results Twelve studies including 556 patients were included for final analysis. No statistically significant difference was observed between the 2 drugs with respect to onset time of surgical anesthesia, onset time of sensory block, onset time of motor block, duration of motor block, and patients overall satisfaction. Levobupivacaine provided more long-term anesthesia (weighted mean difference [WMD], −2.94; 95% confidence interval [CI], −5.56 to −0.32; I² = 93%) and significantly lower incidence of postoperative rescue analgesia (odds ratio [OR], 2.11; 95% CI 1.18–3.74; I² = 21%) than ropivacaine. There was a trend toward greater duration of sensory block in the levobupivacaine group (WMD, −1.16; 95% CI, −1.89 to −0.43; I² = 14%). Conclusion Levobupivacaine is more potent than ropivacaine in peripheral nerve block to some extent. Otherwise, more rigorous randomized control trials are required in the future.
View
Comparision Between Bupivacaine and Ropivacaine in Patients Undergoing Forearm Surgeries Under Axillary Brachial Plexus Block: A Prospective Randomized Study
Article
Full-text available
  • Mar 2015
Brachial plexus block is a suitable alternative to general anaesthesia for patient undergoing upper extremity surgery. Ropivacaine the S-enantiomer emerged as a possible replacement of Bupivacaine without undesirable toxic effects. It provides similar duration of sensory analgesia with early recovery of motor block. Comparision of onset, duration of sensory- motor block and any adverse effects between 0.5% Bupivacaine and 0.5% Ropivacaine in axillary brachial plexus block. Prospective randomized study. This study was carried out in 50 patients between 18-55 y, comparable in demographic variables was randomly allocated to two groups of 25 each. Group I received 30ml 0.5% Bupivacaine, Group II received 30 ml 0.5% Ropivacaine in axillary brachial plexus block for forearm surgeries. Onset, Duration of sensory-motor block, Heart rate, Blood pressure, Oxygen saturation and Respiratory rate were recorded. Statistical analysis used was Statistical Package for Social Sciences version 15.0, Chi-square test was used to evaluate the proportional data. Odds ratio/risk ratios have been calculated wherever necessary. Parametric data has been evaluated using Student t-test while non-parametric data has been evaluated using Mann-Whitney U-test. Onset of motor blockade was earlier in ropivacaine group (5 min) as compared to bupivacaine group (20 min), Higher levels of motor blockade, Mean onset time for motor block was significantly shorter in ropivacaine group (14.88±3.35 min) as compared to bupivacaine group (22.92±3.79 min), Mean duration of block was significantly longer in bupivacaine group (408.40±50.39 min) as compared to ropivacaine group (365.60±34.29 min) (p=0.001), Onset of sensory block was observed from 5 min itself in ropivacaine group as compared to bupivacaine group (10 min), Duration of sensory block was significantly longer in bupivacaine group (450.40±54.50 min) as compared to ropivacaine group (421.20±38.33 min) . On the basis of present study, conclusions were drawn that onset of action of sensory, motor block was early in Ropivacaine group with faster recovery of motor functions as compared to Bupivacaine group. No adverse effects were noted in either groups. This study suggests that Ropivacaine is a suitable alternative to Bupivacaine for forearm surgeries under Brachial Plexus Block.
View
Ropivacaine: A review of its pharmacology and clinical use
Article
Full-text available
  • Mar 2011
  • Indian J Anaesth
Ropivacaine is a long-acting amide local anaesthetic agent and first produced as a pure enantiomer. It produces effects similar to other local anaesthetics via reversible inhibition of sodium ion influx in nerve fibres. Ropivacaine is less lipophilic than bupivacaine and is less likely to penetrate large myelinated motor fibres, resulting in a relatively reduced motor blockade. Thus, ropivacaine has a greater degree of motor sensory differentiation, which could be useful when motor blockade is undesirable. The reduced lipophilicity is also associated with decreased potential for central nervous system toxicity and cardiotoxicity. The drug displays linear and dose proportional pharmacokinetics (up to 80 mg administered intravenously). It is metabolised extensively in the liver and excreted in urine. The present article details the clinical applications of ropivacaine and its current place as a local anaesthetic in the group.
View
Cervical plexus anesthesia for carotid endarterectomy: Comparison of ropivacaine and mepivacaine
Article
Full-text available
  • Mar 2000
To evaluate the effectiveness of cervical plexus block performed with ropivacaine 0.75% or 1%, or mepivacaine 2%. In a prospective, randomized, double-blind study, 60 patients received deep cervical plexus block with 0.2 ml x kg(-1) divided among C2-C4 injections using ropivacaine 0.75% and 1% or mepivacaine 2%. A blinded observer recorded loss of pin-prick sensation every minute in the C2-C4 dermatomes until readiness for surgery. Then, a superficial cervical block was performed with 0.15 ml x kg(-1) lidocaine 1%. The need for intraoperative supplemental analgesia and degree of pain and time of first postoperative pain medication were also recorded. General anesthesia was not required to complete surgery in any case. No differences in the need for intraoperative supplemental analgesia was observed (7, 6, and 9 patients with ropivacaine 0.75% and 1% or mepivacaine 2%, respectively). Readiness to surgery required 15 (10-25) min with ropivacaine 0.75%, 18 (8-20) min with ropivacaine 1%, and 15 (5-20) min with mepivacaine 2% (P = NS); while patients asked for first postoperative pain medication after 10 (4-13) hr and 9 (6.5 - 11) hr with ropivacaine 0.75% and 1% compared with 5 (0-8) hr with mepivacaine 2% (P<0.05). Ropivacaine 0.75% or 1% are appropriate choices when performing cervical plexus anesthesia for carotid endarterectomy, providing nerve block characteristics similar to those of mepivacaine 2%, but with the advantage of longer postoperative pain relief.
View
Association Between Acute Pain and Hemodynamic Parameters in a Postoperative Surgical Intensive Care Unit
Article
  • May 2017
I conducted a prospective repeated-measure study in the general surgery intensive care unit to investigate the associations among acute postoperative pain, analgesic therapy, and hemodynamic parameters. I selected 33 patients and recorded 84 episodes of pain. I measured intensity of pain and hemodynamic parameters after patients were transferred from the postanesthesia care unit to the general surgery intensive care unit, immediately before analgesic therapy and at 15, 30, and 45 minutes after analgesic therapy. Acute pain increased systolic (SBP), diastolic (DBP), and mean arterial blood pressure (MAP); pulse rate (PR); and arterial oxygen saturation. Fifteen minutes after analgesic therapy, SBP and PR decreased, and DBP, MAP, and oxygen saturation increased. Thirty minutes after therapy, SBP, MAP, and PR decreased, and DBP and oxygen saturation increased. Forty-five minutes after therapy, SBP, MAP, and PR decreased, and DBP and oxygen saturation increased. I saw no significant hemodynamic parameter changes during postoperative episodes of pain.
View
Ultrasound guided bilateral cervical plexus block reduces postoperative opioid consumption following thyroid surgery
Article
  • Oct 2014
Thyroid surgery may cause severe postoperative pain and discomfort for patients. Superficial cervical plexus block (SCPB) is one of the regional anesthesia techniques that can provide postoperative analgesia for thyroid surgery. The purpose of this study was to evaluate analgesic effect of ultrasound (US) guided SCPB in patients undergoing thyroid surgery. Fifty ASA I-II patients, aged 20-60, were included in this single blinded study. In a randomized and prospective manner patients were allocated to either SCPB or control group. Bilateral SCPB was performed preoperatively under US guidance using 10 ml 0.25 % bupivacaine for each side. Postoperative analgesia was provided with patient-controlled analgesia method with morphine intravenous. Primary outcome measure was postoperative opioid consumption and analyzed using Mann-Whitney U test. Secondary outcome measures were comparison of opioid side effects like nausea and vomiting and analyzed using Chi square test. VAS scores for pain at postoperative 1st, 6th, 12th, and 24th h were similar in SCPB and control groups (Median VAS values were 2.5, 3, 2, 0 and 3.5, 3, 2, 0 respectively). Postoperative morphine consumption was lower in SCPB group compared to control group at postoperative 6th, 12th, and 24th h (Median doses of morphine consumption were 4, 8, 9 and 5, 9, 11 mg respectively) (P < 0.05). Eight patients in the control group and six patients in the SCBP group had vomiting. Seven patients in the SCPB and none in the control group had hoarseness. Our study has shown that US guided SCPB has a significant analgesic effect in patients undergoing thyroid surgery. Further studies are required to search for the optimal LA dose during US guided SCPB.
View
Randomized clinical trial of intraoperative superficial cervical plexus block versus incisional local anaesthesia in thyroid and parathyroid surgery
Article
  • Dec 2013
  • BRIT J SURG
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).
View