Perioperative analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy: a randomized controlled trial (original) (raw)
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British Journal of Anaesthesia, 2007
Background. The use of regional anaesthesia in thyroid surgery remains controversial. This double-blind, randomized controlled study was conducted to evaluate the analgesic efficacy of bilateral superficial cervical plexus block (BSCPB) performed under general anaesthesia in patients undergoing total thyroidectomy. Methods. Eighty-seven consecutive consenting patients were randomized to receive a BSCPB with saline (Group P, n¼29), ropivacaine 0.487% (Group R, n¼29), or ropivacaine 0.487% plus clonidine 5 mg ml 21 (Group RC, n¼29). Sufentanil was given during the intraoperative period for a 20% increase in arterial mean pressure or heart rate in a patient with a bispectral index between 40 and 60. All patients received 4 g of acetaminophen during the first 24 h after operation. The pain score was checked every 4 h and nefopam was given for pain score .4 on a numeric pain scale. Results. During surgery, the median sufentanil requirements were significantly reduced in Group RC compared with Groups R and P (0.32 vs 0.47 and 0.62 mg kg 21 ; P,0.0001). After surgery, the number of patients requiring nefopam within 24 h of surgery was significantly lower in Groups R and RC than in Group P (16 and 19 vs 25; P¼0.03). At post-anaesthetic care unit admission, median (range) pain scores were significantly lower in Groups R [3 (0-10)] and RC [3 (0-8)] than in Group P [5 (0-8), P¼0.03]. No major complications of BSCPB occurred during study. Conclusions. BSCPB with ropivacaine and clonidine improved intraoperative analgesia. BSCPB with ropivacaine or ropivaciane and clonidine was effective in reducing analgesic requirements after thyroid surgery.
Anesthesiology and Pain Medicine, 2021
Context: Thyroid surgeries done under general anaesthesia use intravenous (iv) drugs as analgesics. A simple superficial cervical plexus block can reduce dose of iv analgesics and provide excellent analgesia. This study evaluated the analgesic efficacy of ultrasound guided Bilateral Superficial Cervical Plexus Block (BSCPB) in thyroidectomies and its opioid sparing effect. Aim: Evaluation of analgesic efficacy of BSCPB and its opioid sparing effect in thyroidectomies. Settings and Design: Routine data based observational study conducted during March 2017 to January 2018 in a tertiary cancer institute in South India. Materials and Methods: The study involved fifty adult ASA I and II patients who received BSCPB with 0.5% ropivacaine 10 ml for thyroidectomies along with general anaesthesia and fifty patients without BSCPB from routine database. Postoperative pain scores for 24 hours were compared and reduction in opioid requirement in BSCPB group was analysed. Statistical analysis: Statistical analysis was done using Statistical package for social sciences package 11 software (SPSS Inc, Chicago). Quantitative data was analysed with Student's t test and categorical data with chi-square test. Friedman two-way ANOVA was used to test significance of pain at different times in BSCPB group. Mann Whitney U test was used to compare pain score between the two groups. Results: There was statistically significant reduction in postoperative pain in the BSCPB group (p=0.0001). The total opioid requirement showed a statistically significant reduction in the BSCPB group (mean ± SD 2.6 ± 2 vs. 6.6 ± 1). Conclusion: BSCPB provides excellent analgesia with a reduction in opioid consumption following thyroidectomies.
Background and Aims: Bilateral superficial cervical plexus block (BSCPB) is effective in reducing pain following thyroid surgeries. Aim of the study is to compare the analgesic efficacy of BSCPB with 0.5% Ropivacaine alone versus 0.5%Ropivacaine with Dexmedetomidine in thyroid surgeries. Methods:60 adult patients belonging to ASA physical status I-II scheduled to undergo thyroid surgeries were randomly divided in to two groups to receive BSCPB,either with 20ml of 0.5% Ropivacaine(Group R) or 20ml of 0.5% Ropivacaine with 0.5µg/kg Dexmedetomidine(Group RD) after induction of anesthesia Visual analogue scale (VAS) was used to assess analgesia postoperatively. Wilcoxon signed rank test and Mann-Whitney U-test were applied for VAS and sedation scores. Unpaired t-test was applied for duration of post-operative analgesia. Results: There was significantly longer duration of analgesia in Group RD and higher patient satisfaction at 24 h. While VAS score for pain were similar up to 6 h, they were lower in Group RD at 12h and 24h. Haemodynamic stability and sedation scores were similar across the groups. There were no adverse events. However, pain during swallowing persisted in both the groups.Conclusion:Combination of 0.5% ropivacaine and dexmedetomidine for BSCPB provided significantly prolonged and better quality of postoperative analgesia than with 0.5% ropivacaine alone in patients undergoing thyroidectomy
International Journal of Medical Sciences, 2000
Purpose: This study was designed to compare the effect on postoperative pain, opioid consumption and the length of stay in postoperative care unit (PACU) after three different intraoperative analgesic regimens in thyroid surgery. Methods: Seventy five patients were enrolled into the study and assigned to one of three groups, fentanyl, sufentanil or remifentanil (n=25 for each group). Before the end of surgery, paracetamol 1 gr and nefopam 20 mg was also administered in all patients. Pain scores, opioid demand and the length of stay in PACU were assessed in a blind manner. Results: Post operative pain scores were significantly lower in the fentanyl and sufentanil groups compared to remifentanil group (55 ± 15, and 60 ± 10 versus 78± 12, P < 0.05). Patients in the remifentanil group stayed longer in the PACU 108± 37 min versus 78±31 and 73 ± 25 min, (P< 0.05). Conclusion: After remifentanil based analgesia, anticipation of postoperative pain with opioid analgesic appears mandatory even for surgery rated as being moderately painful, otherwise longer opioid titration due to higher pain scores might delay discharge time.
SOJ Anesthesiology & Pain Management
Background: Thyroidectomy is associated with mild to moderate type of pain. The employment of regional anesthesia for thyroid surgery remains controversial for some studies. We tested the hypothesis that multiple injection of Bilateral Superficial Cervical Plexus Block (BSCPB) reduced pain scores, opioid consumption and prolongs time of analgesic request after thyroid surgery. Methods: of 45 patients, 40 completed the study. They were allocated in to two groups: the Bilaterela Superficial Cervical Plexus Block (BSCPB) and the control group. The outcome measures were the severity of pain measured on Visual Analogue pain rating Scale (VAS), total opioid consumption, and first analgesic request time during the first postoperative 24 hours. Results: The main outcomes recorded during the first 24 hours were Visual Analogue scale pain score (VAS, 0-10), total opioid consumption and the first analgesic request time. There were VAS scores at rest with median (IQR) in mm 9.00(5.00-16.00) vs. 15.00(10.00-22.00), p < 0.013 and at swallowing with mean ± SD in mm 11.00 ± 8.52 vs 28.70 ± 7.40 p < 0.001for the BSCPB and control group after 24 hours of surgery respectively. It was also showed a statistically significant (p < 0.005) difference observations between the groups throughout the whole period of visit. Twenty four hours after surgery, total tramadol consumption was significantly reduced in cases (BSCPB) and control groups as 550 vs 2350 milligram p < 0.05, respectively. After surgery, time for first analgesic request was significantly prolonged in BSCPB (560.00 vs 26.00, p < 0.001) minutes. Conclusion and recommendation: A multiple injection of BSCPB provided superior analgesia for elective thyroid surgery done under general anaesthesia. We recommend BSCPB to be included as part of multimodal analgesia before intubation for thyroidectomy.
Brazilian Journal of Anesthesiology, 2019
Introduction: Bilateral superficial cervical plexus block (BSCPB) is a common method used for analgesia in thyroid surgery. We investigated the analgesic efficacy of bilateral superficial cervical plexus block in the intraoperative and postoperative periods. Materials and methods: Patients (n = 46) undergoing thyroidectomy were randomly separated into the following 2 groups: the general anesthesia group (GA; n = 23) and the general anesthesia plus BSCPB group (GS; n = 23). The intraoperative analgesic requirement (remifentanil) and visual analog scale (VAS) score at multiple time points during the postoperative period (after extubation, at 15, 30 minutes and 1, 2, 6, 12, 24, and 48 hours post operation) were evaluated. Total tramadol and paracetamol consumption as well as the amount of ondansetron used was recorded. Results: The intraoperative remifentanil requirement was significantly lower in the GS Group than in the GA Group (p = 0.009). The postoperative pain scores were significantly lower in the GS Group than in the GA Group at 15 (p < 0.01), 30 (p < 0.01) minutes, and 1 (p < 0.01), 2 (p < 0.01), 6 (p < 0.01), 12 (p < 0.01) and 24 (p = 0.03) hours. The postoperative tramadol requirement was significantly lower in the GS Group than in the GA Group (p = 0.01). The number of patients that used ondansetron was significantly lower in the GS Group than in the GA Group (p = 0.004). Conclusion: We concluded that BSCPB with 0.25% bupivacaine reduces the postoperative pain intensity and opioid dependency in thyroid surgery patients.
European Archives of Oto-Rhino-Laryngology, 2018
Background and objective We conducted a prospective double-blind randomized study assessing bupivacaine end-of-surgery wound infiltration for pain relief in thyroid surgery. Methods Patients were randomly divided into two groups: Group S, local wound infiltration with saline solution; Group B, bupivacaine 0.5% was administered. Pain perception was measured using visual analogue scale (VAS) during post-anaesthetic care unit (PACU) stay every 10 min and during the 24 postoperative hours admission at 2, 4, 6, 12, and 24 h after surgery. The total consumption of analgesics (morphine and nefopam) was recorded. Results Sixty patients were studied. The VAS scores were significantly lower in the bupivacaine administered group in the post-anaesthetic care unit (PACU) at 0, 10, 20, 30, 40, 50 and 60 min, and during the hospital stay at hours 6, 12, 18 and 24. The number of patients who required postoperative opioid rescue was significantly lower in group B. No patient in group B developed neurological or cardiological complications after infiltration. Conclusion Bupivacaine application is effective in decreasing postoperative pain and analgesic requirement during the hospital stay for patients with thyroidectomy.
Anesthesiology Research and Practice, 2018
Introduction. The pain after thyroid surgery is considered of moderate intensity and short duration. Most trials showed significant reduction in pain intensity and severity of pain in patients for whom bilateral superficial cervical plexus block (BSCPB) was done. Objective. To assess the postoperative analgesic effect of BSCPB for thyroid surgery. Methods. Sixty six euthyroid patients were recruited and assigned to two groups (33 patients each). Group 1 BSCPB and Group 2 standard analgesia. The unpaired Student’s t-test and Mann–Whitney test were used for comparison. Statistical significance was stated at p value < 0.05. Results. The median postoperative pain score (NRS) was 3 in the BSCPB group and 5 in the control group (p=0.002). There was also statistically significant difference at 6th, 12th, and 24th hour showing a lower median pain score in the BSCPB group compared to the control group. The median time was (360 minutes) in the treatment group and (180 minutes) in the contr...
Clinics, 2019
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; po0.001). 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%; po0.001, 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.
Comparison of lornoxicam and low-dose tramadol for management of post-thyroidectomy pain
Agri : Agri (Algoloji) Dernegi'nin Yayin organidir = The journal of the Turkish Society of Algology, 2016
The present study sought to compare the analgesic efficacy and adverse effects of intravenous (IV) lornoxicam and tramadol to investigate if lornoxicam is a reasonable alternative to a weak opioid for post-thyroidectomy pain. Fifty patients of American Society of Anesthesiologists class I or II, 18 to 65 years of age, and who underwent thyroidectomy were assigned to 2 groups in a randomized manner. Group L received 8 mg of lornoxicam IV and Group T received 1 mg/kg of tramadol IV at conclusion of the operation. Pain intensity of patients was recorded at 15 and 30 minutes, and at 1, 2, 3, 4, 6, 12, and 24 hours after the initial dose with Numerical Rating Scale (NRS) and Ramsey Sedation Scale. Electrocardiogram, heart rate, systolic/diastolic and average artery pressure and peripheral oxygen saturations were monitored continuously during this period. Patients completed satisfaction questionnaires at 24th hour. Both drugs produced acceptable analgesia; however, significantly fewer pat...