DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20214715

Utility of bilateral superficial cervical plexus block in thyroidectomy patients for post-operative analgesia

Parth M. Shah, Divya N. Kheskani

Abstract


Background: Thyroidectomy is painful procedure hence multimodal analgesia is required. Superficial cervical plexus block can be used for analgesia in thyroid surgeries. USG guided cervical plexus block administration is safe and latest technique as a part of multimodal analgesia for thyroid surgery.

Methods: After obtaining consent 60 ASA grade I-II adult patients undergoing elective thyroid surgery were included and randomly divided into two groups (group B)-0.25% bupivacaine and (group S)-normal saline. Induction and maintenance under general anesthesia carried out as per standard protocol. After Induction USG guided block was administered with the drug solution as per allocated group. After surgery, patients were extubated and shifted to recovery room. Vital parameters were monitored. Patients were asked about their pain based on the 11-point numerical rating scales (NRS) score. The NRS score and other variables were documented at 3rd hour, 6th hour, 12th hour, and 24th hour at wards after the end of surgery. Time since the end of surgery to the first analgesia request was documented together with total analgesia consumed in the first 24 hours. If NRS score was ≥4 inj. Tramadol iv in incremental doses of 25 mg was given until pain relieved.

Results: Time to first dose of analgesia was higher in group B compared to group S. Total analgesic dose of tramadol during first 24 hours was lower in group B compared to group S

Conclusions: bilateral superficial cervical plexus block can be used as a part of multi-modal analgesia in patients of thyroidectoy.


Keywords


Superficial cervical plexus block, Thyroidectomy, Bupivacaine

Full Text:

PDF

References


Mayhew D. Analgesic efficacy of bilateral superficial cervical plexus block for thyroid surgery: meta-analysis and systematic review. Bri J Anaesthesia. 2018;120(2):241-51.

Shih ML, Duh QY, Hsieh CB. Bilateral superficial cervical plexus block combined with general anesthesia administered in thyroid operations. World J Surg. 2010;34(10):2338-43.

Cousins MJ, Bridenbaugh PO. Neural Blockade in Clinical Anesthesia and Management of Pain. 3rd ed. Pheladelphia, New York: Lippincott-Raven. 1998.

Singh SK. The cervical plexus: Anatomy and ultrasound guided blocks. Anaesth Pain Intensive Care. 2015;19:323-32.

Elmaddawy AE, Mazy AE. Ultrasound-guided bilateral superficial cervical plexus block for thyroid surgery: The effect of dexmedetomidine addition to bupivacaine-epinephrine. Saudi J Anaesth. 2018;12:412-8.

Herring AA, Stone MB, Frenkel O, Chipman A, Nagdev AD. The ultrasound-guided superficial cervical plexus block for anesthesia and analgesia in emergency care settings. Am J Emerg Med. 2012;30:1263-7.

Winstanley S, Parkinson F, Rassam SS, Scott-Coombes D, Stechman MJ. Comparison of local anaesthetic wound infiltration and bilateral superficial cervical plexus block for thyroid and parathyroid surgery: 2AP2-7. Euro J Anaesthesiol. 2012;29:35.

Marhofer ZP, Schrögendorfer K, Wallner T, Koinig H, Mayer N, Kapral S et al. Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks. Reg Anesth Pain Med. 1998;23:584-8.

Aweke Z, Sahile WA, Abiy S, Ayalew N, Kassa AA. Effectiveness of Bilateral Superficial Cervical Plexus Block as Part of Postoperative Analgesia for Patients Undergoing Thyroidectomy in Empress Zewditu Memorial Hospital, Addis Ababa, Ethiopia. Anesthesiol Res Practice. 2018;6107674:6.

Shih ML, Duh QY, Hsieh CB, Liu YC, Lu CH, Wong CS et al. Bilateral superficial cervical plexus block combined with general anesthesia administered in thyroid operations. World J Surg. 2010;34(10):2338-43.

Çanakçı E, Taş N, Yağan O, Genç T. Effect of bilateral superficial cervical block on postoperative analgesia in thyroid surgery performed under general anesthesia. Ege J Med. 2015;54(4):182-6.

Dieudonne N, Gomola A, Bonnichon P, Ozier Y. Prevention of postoperative pain after thyroid surgery: a double-blind randomized study of bilateral superficial cervical plexus blocks. Anesthesia Analgesia. 2001;92:6:1538-42.

Eastern Metropolitian Region Palliative Care Consortium (Victoria), Opioid Conversion Ratios-Guide to Palliative Care Practice. 2016. Available at: http://www.emrpcc.org.au. Accessed on 25 March 2021.

Gurkan Y, Tas Z, Toker K, Solak M. Ultrasound guided bilateral cervical plexus block reduces postoperative opioid consumption following thyroid surgery. J Clin Monit Comput. 2015;29(5):579-84.

Marhofer P, Chan VW. Ultrasound-guided regional anesthesia: current concepts and future trend. Anesth Analg. 2007;104(5):1265-9.

Kessler J, Gray AT. Ultrasound guidance for regional anesthesia. In: Miller RD, Cohen NH, Eriksson LI, editors. Miller’s Anesthesia. 8th ed. Philadelphia: Elsevier. 2015;1752-66.

Gurkan Y, Tas Z, Toker K, Solak M. Ultrasound guided bilateral cervical plexus block reduces postoperative opioid consumption following thyroid surgery. J Clin Monit Comput. 2015;29(5):579-84.

Urmey WF, Stanton J. Inability to consistently elicit a motor response following sensory paresthesia during interscalene block administration. Anesthesiology. 2002;96:552-4.

Abrahams MS, Aziz MF, Fu RF, Horn JL. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: A systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2009;102:408-17.