Abstract
BackgroundParathyroidectomy has been proposed as a method for reducing parathyroid hormone levels. We evaluated the effects of ultrasound-guided bilateral superficial cervical plexus block (BSCPB) on the quality of recovery of uremia patients with secondary hyperparathyroidism (SHPT) following parathyroidectomy.MethodsEighty-two uremia patients who underwent parathyroidectomy and exhibited SHPT were randomly allocated to the BSCPB group or the control group (CON group). The patients received ultrasound-guided BSCPB with 7.5 ml of ropivacaine 0.5% on each side (BSCPB group) or equal amount of 0.9% normal saline (CON group). The primary outcome of the Quality of Recovery-40(QoR-40) score was recorded on the day before surgery and postoperative day 1(POD1). Secondary outcomes including total consumption of remifentanil, time to first required rescue analgesia, number of patients requiring rescue analgesia, and total consumption of tramadol during the first 24 h after surgery were recorded. The occurrence of postoperative nausea or vomiting (PONV) and the visual analogue scale (VAS) scores were assessed and recorded.ResultsThe scores on the pain and emotional state dimensions of the QoR-40 and the total QoR-40 score were higher in the BSCPB group than in the CON group on POD1 (P = 0.000). Compared with the CON group, the total consumption of remifentanil was significantly decreased in the BSCPB group (P = 0.000). The BSCPB group exhibited longer time to first required rescue analgesia (P = 0.018), fewer patients requiring rescue analgesia (P = 0.000), and lower postoperative total consumption of tramadol during the first 24 h after surgery (P = 0.000) than the CON group. The incidence of PONV was significantly lower in the BSCPB group than in the CON group (P = 0.013). The VAS scores in the BSCPB group were lower than those in the CON group at all time-points after surgery (P = 0.000).ConclusionUltrasound-guided BSCPB with ropivacaine 0.5% can enhance the quality of recovery, postoperative analgesia, and reduce the incidence of PONV in uremia patients with SHPT following parathyroidectomy.Trial registrationChiCTR1900027185. (Prospective registered). Initial registration date was 04/11/2019.
Highlights
Parathyroidectomy has been proposed as a method for reducing parathyroid hormone levels
Compared with the CON group, the total consumption of remifentanil was significantly decreased in the bilateral superficial cervical plexus block (BSCPB) group (P = 0.000) (Table 2)
The incidence of postoperative nausea or vomiting (PONV) was significantly lower in the BSCPB group (4.9%) than the CON group (24.4%) (P = 0.013) (Table 4)
Summary
Parathyroidectomy has been proposed as a method for reducing parathyroid hormone levels. We evaluated the effects of ultrasound-guided bilateral superficial cervical plexus block (BSCPB) on the quality of recovery of uremia patients with secondary hyperparathyroidism (SHPT) following parathyroidectomy. Secondary hyperparathyroidism (SHPT) is a common disorder of calcium, phosphorus and vitamin D metabolism in patients with end-stage renal disease (ESRD) that results in mineral imbalance and bone disorders, especially in dialysis patients [1]. If parathyroid hormone levels are persistently elevated >800 pg/ ml (>6 months) and pharmacological therapy remains ineffective, uremia patients with SHPT may undergo parathyroidectomy [4]. ESRD affects the metabolism and excretion of opioid analgesics and muscle relaxants, which can prolong postoperative recovery [9, 10]. Uhlmann et al [6] demonstrated that mild to moderate pain after parathyroidectomy may render patients ineligible for postoperative recovery programs. A previous study showed that two-thirds of patients undergoing parathyroidectomy require narcotic analgesics to relieve postoperative pain on the first day after surgery, whereas the incidences of postoperative nausea, vomiting and apnea or respiratory depression increase [11,12,13]
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