Abstract
BackgroundThyroidectomy is a common procedure that causes mild trauma. Nevertheless, postoperative pain remains a major challenge in patient care. Multimodal analgesia comprising a combination of analgesics and analgesic techniques has become increasingly popular for the control of postoperative pain. The present study tested the hypothesis that multimodal analgesia with combined ropivacaine wound infiltration and intravenous flurbiprofen axetil after radical thyroidectomy provided better analgesia than a single dosage of tramadol.MethodsThis randomized controlled trial was conducted in a tertiary hospital. Forty-four patients (age, 18–75 years; American Society of Anesthesiologists status I or II; BMI < 32 kg/m2) scheduled for radical thyroidectomy were randomly assigned to a multimodal analgesia group (Group M) or a control group (Group C) by random numbers assignments, and 40 patients completed the study. All participants and the nurse in charge of follow-up observations were blinded to group assignment. Anesthesia was induced with sufentanil, propofol, and cisatracurium. After tracheal intubation, Group M received pre-incision wound infiltration with 5 ml of 0.5% ropivacaine mixed with epinephrine at 1:200,000 (5 μg/ml); Group C received no wound infiltration. Anesthesia was maintained with target-controlled infusion of propofol, remifentanil, sevoflurane, and intermittent cisatracurium. Twenty minutes before the end of surgery, Group M received 100 mg flurbiprofen axetil while Group C received 100 mg tramadol. Postoperative pain was evaluated with the numerical rating scale (NRS) pain score. Remifentanil consumption, heart rate, and noninvasive blood pressure were recorded intraoperatively. Adverse events were documented. The primary outcome was analgesic effect according to NRS scores.ResultsNRS scores at rest were significantly lower in Group M than in Group C before discharge from the postoperative anesthetic care unit (P = 0.003) and at 2 (P = 0.008), 4 (P = 0.020), and 8 h (P = 0.016) postoperatively. Group M also had significantly lower NRS scores during coughing/swallowing at 5 min after extubation (P = 0.017), before discharge from the postoperative anesthetic care unit (P = 0.001), and at 2 (P = 0.002) and 4 h (P = 0.013) postoperatively. Compared with Group C, NRS scores were significantly lower throughout the first 24 h postoperatively in Group M at rest (P = 0.008) and during coughing/swallowing (P = 0.003). No serious adverse events were observed in either group.ConclusionMultimodal analgesia with ropivacaine wound infiltration and intravenous flurbiprofen axetil provided better analgesia than tramadol after radical thyroidectomy.Trial registrationChinese Clinical Trial Registry (registration number # ChiCTR1800020290; date of registration: 22/12/2018).
Highlights
Thyroidectomy is a common procedure that causes mild trauma
numerical rating scale (NRS) scores at rest were significantly lower in Group M than in Group C before discharge from the postoperative anesthetic care unit (P = 0.003) and at 2 (P = 0.008), 4 (P = 0.020), and 8 h (P = 0.016) postoperatively
Patients with the following conditions were excluded from the study: 1) history of chronic pain or chronic use of analgesics; 2) intake of non-steroidal anti-inflammatory drug (NSAID), opioids, or other analgesics in the 24 h before surgery; 3) history of allergic reaction to NSAIDs; 4) any contraindications to flurbiprofen axetil, such as coagulation disorders, gastrointestinal ulceration, severe hypertension, severe cardiovascular or cerebrovascular disease, or renal dysfunction; 5) pregnancy or lactation; 6) inability to comprehend the concept of the numeric rating scale (NRS; 0, no pain; 10, worst pain imaginable); 7) lateral neck dissection during surgery; and 8) refusal to participate in the study
Summary
Thyroidectomy is a common procedure that causes mild trauma. postoperative pain remains a major challenge in patient care. The present study tested the hypothesis that multimodal analgesia with combined ropivacaine wound infiltration and intravenous flurbiprofen axetil after radical thyroidectomy provided better analgesia than a single dosage of tramadol. Tramadol is commonly prescribed to provide postoperative analgesia in patients undergoing thyroid surgery because it is effective in relieving mild to moderate pain, causes less respiratory depression and sedation than other opioids, and has a relatively low cost. Tramadol has major adverse effects, including dizziness, nausea, and vomiting, which affect its clinical application and patient satisfaction [5]. Clinical research shows that postoperative nausea and vomiting (PONV) is primarily caused by the use of inhalational anesthesia and opioid analgesics [6]. Despite impressive advances in the field of anesthesia, PONV remains an unpleasant postoperative experience that must be considered
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