Abstract
BackgroundWe evaluated the efficacy of a new anesthetic technique termed ultrasound-guided capsule-sheath space block (CSSB) combined with anterior cervical cutaneous nerve block (CCNB) for thyroidectomy.MethodsThe study included two parts: Part one was an imaging study to determine technique feasibility. The CSSB was performed on five healthy volunteers by introducing the needle 0.5 cm lateral to the probe under in-plane needle ultrasound guidance. After puncture of the false capsule and its subsequent contraction with the true capsule of thyroid, 10 mL of contrast medium was deposited slowly in the capsule-sheath space. The CCNB was performed bilaterally as follows: Under ultrasound guidance, a subcutaneous injection was made along the sternocleidomastoid using 10 mL of contrast medium which was followed by a girdle-shaped picchu raised from the cricoid cartilage to supraclavicular region. The spreading pattern of contrast medium was imaged using computed tomographic scanning. In part two (a clinical case series) the technique efficacy was evaluated. Seventy-eight patients undergoing thyroidectomy had ultrasound-guided CSSB and CCNB with local anesthetics. The sensory onset of CCNB, intraoperative hemodynamic parameters, and analgesic effect were assessed and complications were noted.ResultsThe distribution of contrast medium was well defined. In part two the onset time of CCNB was 2.2 ± 0.7 min, and the hemodynamic parameters remained stable intraoperatively. The recall of visual analogue scale scores during surgery was 2 [1–4] for median (range). The patients’ and surgeons’ satisfaction scores were 2 [1–4] and 1 [1–3] for median (range). No serious complications occurred.ConclusionsCombining ultrasound-guided CSSB and CCNB is a feasible, effective and safe technique for thyroidectomy.Trial registrationCurrent Controlled Trials ChiCTR-ONC-12002025. Registered 19 March 2012.
Highlights
We evaluated the efficacy of a new anesthetic technique termed ultrasound-guided capsule-sheath space block (CSSB) combined with anterior cervical cutaneous nerve block (CCNB) for thyroidectomy
Imaging study The computed tomography (CT) imaging distinctly demonstrated the spread of the contrast medium along the sternocleidomastoid muscle (SCM) muscles bilaterally in the superficial compartment
Contrast medium reached the posterior aspect of the poles (Figure 6)
Summary
We evaluated the efficacy of a new anesthetic technique termed ultrasound-guided capsule-sheath space block (CSSB) combined with anterior cervical cutaneous nerve block (CCNB) for thyroidectomy. The superficial branches, in their course towards the cervical tegument, perforate the investing layer of deep cervical fascia at the “nerve point of the neck” located in the middle of the posterior edge of sternocleidomastoid muscle (SCM). They are distributed as four distinct nerves: the lesser occipital, greater auricular, transverse cervical, and supraclavicular nerves. We hypothesized that girdle-shaped injection of local anesthetic along SCM muscle in the subplatysma fat layer would effectively block the superficial cutaneous nerves and allow painless skin incision for thyroidectomy
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