Bilateral Superficial Cervical Plexus Block Research Articles

Post-thyroidectomy bilateral cervical plexus block relieves pain: a systematic review.

To assess the effectiveness of bilateral superficial cervical plexus block (BSCPB) in treating post-thyroidectomy pain. MEDLINE, Embase, Google Scholar, LILACS, and the Cochrane Central Register of Controlled Trials, were extensively searched. The search period extended from 1968 until December 2022. Randomized controlled trials comparing BSCPB to placebo, no block in patients with thyroidectomy for benign or malignant thyroid disease were included. Outcomes werepain in the first 24h after surgery. Analgesic rescue, period before the first rescue dosage, and 24-h opioid usage were secondary outcomes. The RoB 2 instrument was used to evaluate the risk of bias. 34 of 354 studies were eligible. There were 2,519 patients. BSCPB reduced the intensity of painpostoperatively[SMD:-1.17(95%CI:-1.54to-0.81)] andin the first 24h [-0.62 (95%: 0.91 to 0.33)]. A considerable delay for the first opioiddose, rescue analgesics, and postoperative opioid usage was also found. BSCPB's 24-h analgesic efficacy minimizes the requirement for rescue analgesia, postoperative opioid intake, and rescue analgesia start time. The choice of anesthetic and different application methods might affect its effectiveness.

Effectiveness and safety of electroacupuncture analgesia in controlling intraoperative pain and hemodynamics during total thyroidectomy: A randomized controlled trial

ObjectiveTo evaluate the effectiveness and safety of electroacupuncture in conjunction with additional medications in providing analgesia and stabilizing hemodynamic parameters during total thyroidectomy. MethodsThis randomized controlled trial included 100 patients who underwent a total thyroidectomy between October 2022 and October 2023 at the Vietnam National Hospital of Acupuncture. The patients were randomized into two groups. The electroacupuncture analgesia (EA) group received EA stimulation at five acupuncture points: Hegu (LI 4), Neiguan (PC 6), Shuitu (ST 10), Quepen (ST 12), and Yifeng (SJ 17), while the control group received a bilateral superficial cervical plexus block. Primary outcomes included the level of analgesia and perioperative vital signs in both groups. Additionally, pain thresholds and serum β-endorphin levels were measured before and after electroacupuncture in the EA group. ResultsComplete analgesia (Level A) was attained in 86% and 76% of the patients in the EA and control groups, respectively, with no significant difference between the two groups (P = 1.00). In the EA group, the mean pain threshold after receiving EA doubled (648.7 (77.4) g/s vs. 305.3 (45.3) g/s, P < .001), and the mean serum β-endorphin level increased by approximately 13.5 pg/mL (P < .001). All patients remained hemodynamically stable throughout the surgery. ConclusionEA, in conjunction with additional medications that stimulate five acupuncture points, LI 4, PC 6, ST 10, ST 12, and SJ 17, was well tolerated and effectively maintained a suitable level of analgesia and hemodynamic stability during total thyroidectomy.

Blok Pleksus Servikalis Superfisialis pada Insisi Abses Submandibula

This case study explores the use of bilateral superficial cervical plexus block as a regional anesthesia method in a 44-year-old male patient with a submandibular abscess. The patient, who has comorbidities of type 2 diabetes mellitus, renal insufficiency, and grade 1 obesity, underwent a 60-minute abscess drainage incision operation. This technique was chosen based on patient factors and the medical team's preference, avoiding the risks associated with general anesthesia. Lidocaine 2% at 6cc per side was used, demonstrating the effectiveness of the cervical plexus block in this procedure and others such as lymph node dissection and laceration repair. The study confirms that regional anesthesia guided by ultrasound is a quick, resource-efficient, and safe option, with the potential to avoid improper analgesic dosing. For longer procedures, local anesthetics like ropivacaine or bupivacaine can be utilized. The main conclusion is that the superficial cervical plexus block is an effective and safe alternative for anesthesia in certain neck procedures.

Effect of ultrasound-guided bilateral superficial cervical plexus block versus perioperative intravenous lidocaine infusion on postoperative quality of recovery in patients undergoing thyroidectomy: A randomised double-blind comparative trial.

Recent studies have found that ultrasound-guided (USG) bilateral superficial cervical plexus block (BSCPB) and intravenous infusion of lidocaine (IVL) have the potential to improve the quality of postoperative recovery. This study aimed to investigate and compare their effects on postoperative quality of recovery in patients undergoing thyroidectomy. A total of 135 patients were randomised to Group N: BSCPB with 10 mL 0.75% ropivacaine on each side, Group L: intravenous lidocaine (1.5 mg/kg for 10 min, followed by 1.5 mg/kg/h) and Group C: intravenous saline combined with BSCPB saline. The primary objective was quality of recovery-40 (QoR-40). Other parameters compared were numeric rating pain scale (NRS) score, haemodynamic data, opioid dosage and incidence of adverse effects. Statistical analysis was performed using the one-way analysis of variance (ANOVA), the Kruskal-Wallis test and the Chi-square test. Compared to Group C, both groups N and L had higher QoR-40 total scores as well as scores indicating physical comfort, emotional state and pain dimensions on postoperative day (POD) 1 and POD2 (P < 0.001). The QoR-40 total and pain dimension scores in Group N were higher on POD1 and POD2 (P < 0.05). The NRS scores and the change in haemodynamics were lower in Group N compared to groups L and C (P < 0.05). The results of other parameters were lower in groups N and L than in Group C (P < 0.05). USG BSCPB and IVL are comparable in improving the quality of postoperative recovery in patients undergoing thyroidectomy.

The analgesic effects of bilateral superficial cervical plexus block in thyroid surgery: A systematic review and meta-analysis.

Thyroid surgery is moderately painful, and many techniques to reduce postoperative pain have been studied. Regional techniques are a part of multimodal analgesia employed for various surgical cases. Bilateral superficial cervical plexus block (BSCPB) is a commonly used regional anaesthesia technique for analgesia for thyroid surgery. A previous meta-analysis by this group had left questions about some facets of the technique, to which further trials have contributed. The systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) CRD42022315499. It is an update to a previously published paper in 2018. An updated systematic search, critical appraisal, and analysis of clinical trials were performed. Trials investigating preoperative or postoperative BSCPB compared to control in patients undergoing thyroid surgery were included in the search. The primary outcome was postoperative opioid consumption. The secondary outcomes were the duration of analgesia (time to request of analgesia), Visual Analogue Scale (VAS) pain scores at 0, 4, 12, and 24 h, postoperatively, rates of postoperative nausea and vomiting (PONV), postoperative rescue analgesic consumption, and intraoperative morphine use. A total of 31 studies and 2,273 patients were included in this analysis. BSCPB significantly reduced post-thyroidectomy opioid consumption (P < 0.001). Additionally, the duration of analgesia was prolonged following BSCPB. VAS scores for 24 h (postoperatively), intraoperative morphine use, and rescue analgesia (postoperatively) remained significantly lower in patients who received BSCPB. There was also a statistically significant reduction in PONV (P = 0.02). BSCPB offers superior postoperative analgesia with a reduction in opioid use, reduction in PONV, and improvement in VAS scores.

Ketorolac Administration with Ketorolac and Bilateral Superficial Cervical Plexus Block's Comparison to Total Post-Thyroidectomy Analgesic Rescue Needs

Thyroidectomy is generally performed by a surgeon with a short operating duration. Inadequate postoperative pain treatment results in several physiological and psychological outcomes, including prolonged hospital stays and the development of chronic pain. This study aims to compare the administration of ketorolac with a combination of ketorolac and bilateral superficial cervical plexus blocks to the total need for analgetic rescue after thyroidectomy surgery. This study used an experimental study with a single-blind randomized control trial method for both study groups. After surgery, group A was given an IV injection of 30 mg ketorolac, while group B was given IV injections of 30 mg ketorolac and bilateral superficial cervical plexus block under ultrasound guidance and 10 ml of 0.25% bupivacaine on each side of the neck before surgery was completed. Both groups would be monitored for 2 hours. The average value of total analgetic rescue needs in the patient group given ketorolac was 195.24 ± 72.72 mcg. While the total need for analgetic rescue in the group of patients who were given a combination of ketorolac and bilateral superficial cervical plexus blocks was 44.05 ± 19.21 mcg. The results of the unpaired T-test showed a p-value of 0.001. There is a significant difference in the total need for analgetic rescue in patients receiving ketorolac.

Bilateral Superficial Cervical Plexus Block in Thyroid Surgery with Intravenous versus Local Infiltration of Dexamethasone – A Randomized Single Blinded Comparative Study

Background: Post-operative pain for thyroid surgeries under general anaesthesia is inadequately managed. Bilateral superficial cervical plexus block (BSCPB) for thyroid surgery causes adequate analgesia without any significant side effects. Dexamethasone is commonly used in anaesthesia to prevent postoperative nausea and vomiting (PONV). The study objective was comparison of efficacy between add-on Dexamethasone intravenously and Ropivacaine alone in bilateral superficial cervical plexus block versus Dexamethasone added with Ropivacaine in the same block in producing postoperative analgesia and in preventing post-operative nausea vomiting. Methods: Randomized single-blind clinical study was done on eighty patients of 18-60 years of either sex, ASA I and II, scheduled for elective thyroid surgery under general anaesthesia. Patients were divided into two groups (n=40). In bilateral superficial cervical plexus block, Group DB (n=40) had received 20 ml Inj. Ropivacaine (0.25%) and 2ml (8 mg) Inj. Dexamethasone and Group DI (n=40) had received 20ml Inj. Ropivacaine (0.25%) and 2 ml of distilled water, along with 2 ml IV distilled water in DB group and Inj. Dexamethasone 2ml (8 mg) IV in DI group. Time of rescue analgesia with VAS (Visual Analogue Scale) score of that moment and incidence of PONV were noted up to 24 hrs post-operatively. Results: No statistically significant difference was found among the two groups in respect of time of rescue analgesia, VAS score and incidence of PONV. Conclusion: From our study, we conclude that different routes of administration of Inj. Dexamethasone during BSCPB has no extra benefit in respect of postoperative analgesia and incidence of PONV in thyroid surgery.

Comparison between ultrasound guided and landmark – based technique for superficial cervical plexus block in patients undergoing thyroid surgery

Background: The major advantage of ultrasound guided technique over the traditional landmark technique in bilateral superficial cervical plexus block is that, it helps to minimize the injury to cervical muscle, fascia and nerves. The study aimed to compare the effectiveness between landmark technique and ultrasound guided technique with respect to the post-operative analgesia, intra-operative hemodynamics and the complication rate of the procedure. Methodology: A total of 100 patients were included as our study sample which was divided into two groups of 50 each. Group A patients received Superficial Cervical Plexus Block (SCPB) using the landmark based technique and Group B patients received SCPB under ultrasound guided technique. Parameters such as success of the procedure performance time, time of onset of action, block pain score, post-operative pain score, intra-operative hemodynamics and complication rate were compared between the two groups. Results: The success rate of the block was found to be 72% in the landmark technique group compared to 90% in the ultrasound guided group. The onsite time of analgesia was found to be much earlier in ultrasound guided group (16.2 vs 11.1 mins). The hemodynamic parameters were found to be slightly higher among the landmark group compared to ultrasound guided group. Post-operative pain score was significantly better and the incidence of complication rate was nil among ultrasound guided group. Conclusion: Ultrasound guided technique is a better alternate for landmark technique for providing bilateral superficial cervical plexus block while performing thyroidectomy surgery. Keywords: cervical plexus block; landmark technique; ultrasound technique; thyroidectomy

Efficacy of Bilateral Superficial Cervical Plexus Block for Postoperative Analgesia in Thyroidectomy

Efficacy of Bilateral Superficial Cervical Plexus Block for Postoperative Analgesia in Thyroidectomy

Post-operative analgesic efficacy of 0.25% ropivacaine with dexmedetomidine versus dexamethasone as an adjuvant in bilateral superficial cervical plexus block for thyroidectomy under general anaesthesia - A comparative randomized clinical study.

The bilateral superficial cervical plexus block (BSCPB) is efficacious for post-operative analgesia in thyroid surgeries. We assessed the analgesic efficacy of dexmedetomidine and dexamethasone administered as adjuvants with 0.25 percent ropivacaine in BSCPB for thyroidectomy under general anaesthesia with regard to the duration of analgesia, total amount of rescue analgesic requirement, changes in intra- and post-operative haemodynamic parameters, VAS scores, and adverse events, if any. A prospective double-blind trial was planned with 80 adults undergoing thyroidectomy, randomized into two equal groups and given BSCPB with 20 ml 0.25% ropivacaine with adjuvants as either dexmedetomidine 50mg (group A) or dexamethasone 4mg (group B), 10 ml on each side, after the induction of general anaesthesia. Post-operative pain was monitored using the visual analog scale and the duration of analgesia was measured by time to first rescue analgesia. Post-operative haemodynamics and any adverse events were recorded. The mean duration of analgesia was slightly prolonged in group A but statistically non-significant as compared to group B (1037 ± 97 vs. 1004 ± 122 minutes; P0.18). The post-operative median VAS scores and vital parameters were relatively comparable for both groups (P > 0.05) for the first 24h. There was a significant reduction in the incidence of PONV (P < 0.05) in group B. Although dexamethasone offers a slight advantage of decreased incidence of PONV, BSCPB using ropivacaine with either dexmedetomidine or dexamethasone as an adjuvant imparted adequate analgesia with stable haemodynamics and may be used as a pre-emptive analgesic technique in thyroid surgeries.

A comparison of efficacy of parenteral and perineural dexmedetomidine with 0.25% ropivacaine for post-thyroidectomy analgesia using bilateral superficial cervical plexus block.

Opioids are conventionally used for post-thyroidectomy pain, regional anesthesia is becoming popular due to its feasibility and efficacy in minimizing use of opioids and hence its side effects. This study compared analgesic efficacy of bilateral superficial cervical plexus block (BSCPB) using perineural and parenteral dexmedetomidine with 0.25% ropivacaine in thyroidectomy patients. In this double-blind study, 60 American Society of Anesthesiologists (ASA) physical status I and II thyroidectomy patients, aged 18-65 years were randomized into two groups. Group A (n = 30) received BSCPB with 0.25% ropivacaine, 10 mL on each side with dexmedetomidine 0.5 μg/kg IV infusion. Group B (n = 30) received 0.25% ropivacaine plus dexmedetomidine 0.5 μg/kg, ten mL on each side. Duration of analgesia by measuring pain visual analog scores (VAS), total dose of analgesic requirement, Haemodynamics parameters and adverse events were recorded for 24 h. Categorical variables were analyzed using Chi-square test and continuous variables were computed as mean with standard deviation and analyzed using independent sample t-test. Mann-Whitney U test was used for analysis of ordinal variables. Time to rescue analgesia was longer in Group B (18.6 ± 3.27 h) as compared to Group A (10.2 ± 2.11 h) (P < 0.001). Total analgesic dose required was also found to be lesser in Group B (50.83 ± 20.37 mg) as compared to Group A (73.33 ± 18.27 mg) (P < 0.001). No significant hemodynamic changes or side effects were observed in both groups; (P > 0.05). Perineural dexmedetomidine with ropivacaine in BSCPB significantly prolonged the duration of analgesia with reduced rescue analgesic requirement.

Ultrasound Guided Bilateral Superficial Cervical Plexus Block Plus Tolerable Endotracheal Tube Versus Conventional Systemic Analgesia for Thyroid Surgeries

Ultrasound Guided Bilateral Superficial Cervical Plexus Block Plus Tolerable Endotracheal Tube Versus Conventional Systemic Analgesia for Thyroid Surgeries

Levobupivacaine versus levobupivacaine – dexmedetomidine for ultrasound guided bilateral superficial cervical plexus block for upper tracheal resection and reconstruction surgery under general anesthesia

ABSTRACT Background Anesthesia for repair of tracheal stenosis considered as a challenging that needs to optimize the immediate postoperative period and preventing unwise use of postoperative opioid. This study was designed to evaluate the analgesic efficacy of adding dexmedetomidine to levobupivacaine for blocking the superficial cervical plexus for tracheal reconstruction. Methods Eighty patients, underwent elective surgical repair of upper tracheal stenosis and reconstruction. Patients were randomly allocated into two groups and received ultrasound guided bilateral superficial cervical plexus block. Group L received 10 ml of 0.5% Levobupivacaine. Group D received 10 ml of 0.5% Levobupivacaine and 0.5 µg⁄kg dexmedetomidine in each side. The total postoperative analgesic consumption, postoperative pain severity and the time to the first analgesic requirement were evaluated in all patients. Results Total postoperative fentanyl consumption decreased in group D (76.75 ± 9.57 µg) versus (176.75 ± 22.66 µg) in group L with p value ≤ 0.001 and time to first analgesic requirement was longer in group D (20.70 ± 5.42 hours) versus (8.35 ± 2.55 hours) in group L. Moreover, increased plasma cortisol level during surgery and after recovery in group L compared with group D with p value ≤ 0.001. Conclusion : Addition of dexmedetomidine to levobupivacaine for bilateral superficial cervical plexus block considered as an effective and safe block that significantly reduced total postoperative opioid consumption and prolonged time to first postoperative analgesic request with achievement of good quality of analgesia.

Use of Bilateral Superficial Cervical Plexus Block for Excision of Thyroglossal Duct Cyst in an ASA III Patient.

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The strategy of non-intubated spontaneous ventilation anesthesia for upper tracheal surgery: a retrospective case series study.

BackgroundUpper tracheal surgery is used to treat patients who with tracheal tumors or tracheal stenosis. The non-intubated spontaneous ventilation anesthesia (NSVA) may have advantages over endotracheal intubation and surgical cross-field intubation in upper tracheal surgery. This study aimed to illustrate and assess the feasibility of NSVA strategy for upper tracheal surgery.MethodsThis is a retrospective case series study in which 51 patients (from May 2015 to August 2020) who met the criteria in NSVA strategy were analyzed. Anesthesia was performed using total intravenous anesthesia (TIVA) combined with bilateral superficial cervical plexus block (CPB) or thoracic epidural anesthesia (TEA). Patients received spontaneous ventilation through laryngeal mask airway (LMA) during the surgery. Anesthesia conversion technique was applied to patients who met the anesthesia conversion criteria.ResultsIn total, 51 patients met the NSVA criteria and were included in this study. Forty-six out of 51 patients (90%) had TIVA + bilateral superficial CPB and five patients (10%) had TIVA + TEA + CPB. During the airway-opened period, 46 patients had stable spontaneous ventilation. Five patients need anesthesia conversion, two patients had high-frequency ventilation (HFV), and three patients required cross-field intubation. Postoperative complications occurred in seven (14%) patients, no reintubation was needed after surgery. The median postoperative hospital stay was 6.31±4.30 days.ConclusionsThis NSVA strategy includes criteria for patient selection, preoperative assessment, surgical technique, airway management, criteria and technique for anesthesia conversion. The NSVA strategy is a feasible procedure in upper tracheal surgery.

Bilateral superficial cervical plexus block with conscious sedation for thyroid surgery

Total thyroidectomy can safely be performed by bilateral superficial cervical plexus blockade which is a regional anesthetic technique to anaesthetize superficial branches of the anterior primary rami of cervical 3-5 spinal nerves. Conscious sedation with this anesthetic technique enhance safe and faster recovery compared to general anesthesia (GA) with endotracheal intubation which is traditionally employed technique for thyroidectomy. This randomized active control trial was conducted in the department of Anaesthesia, Analgesia and Intensive care medicine, Bangabandhu Sheikh Mujib Medical University from January to December 2018 to compare perioperative outcome between bilateral superficial cervical plexus blockade and GA technique during total thyroidectomy. Total 60 patients of American Society of Anesthesiol- ogists Classification grade I and II who were selected for thyroidectomy were randomly divided into Group-A(n=30) and Group-B (n=30). Group A received with 0.5% bupivacaine and 1% lignocaine; and group B received general anesthesia during total thyroidectomy. Heart rate, systolic blood pressure, diastolic blood pressure mean arterial blood pressure , oxygen satura- tion (SPO2) were recorded and compared between the groups. Operative site bleeding, surgeon’s satisfaction &amp; post operative pain were measured with Boezaart Scoring system, Likert scale &amp; visual analogue scale repectively; and compared between two groups. During induction, systolic and diastolic blood pressure were high in group B and reduced in group A which were statistically significant. Systolic and diastolic blood pressure was significantly reduced in Group-A in comparison to Group-B after 5 minutes, 30 minutes, 45 minutes and at the end of operation. Bilateral superficial cervical plexus blockade reduced pain more effective- ly than GA group &amp; it was statistically significant. Mean value of bleeding score were also statis- tically significant in Group-A. Regarding surgeons’ satisfaction, there was no statistically signif- icant difference between the groups. Bilateral superficial cervical plexus block with conscious sedation provided better outcome in terms of perioperative hemodynamics, pain and surgical site bleeding compared to general anaesthesia. BSMMU J 2021; 14(4): 104-108

Effect of Bilateral Superficial Cervical Plexus Block on Postoperative Analgesic Consumption in Patients Undergoing Thyroid Surgery.

PurposePatients complain of moderate-intensity pain following thyroid surgery. Superficial cervical plexus block (SCPB) can be employed as a component of multimodal analgesia after thyroid surgery. This double-blind, randomized study aimed to compare the effects of bilateral SCPB (BSCPB) on postoperative analgesic requirements following thyroid surgery.MethodsA total of 60 American Society of Anesthesiologists (ASA) I-II patients who underwent elective total thyroidectomy under general anesthesia were randomly assigned to Group 1 and Group 2. After inducing general anesthesia, BSCPB was not administered to Group 1, whereas BSCPB was administered using a three-point injection technique with 0.5% levobupivacaine in Group 2. Patient-controlled analgesia (PCA) was applied by using tramadol in both groups for postoperative analgesia. Tenoxicam was administered as rescue analgesic to patients in case of numeric rating scale (NRS) >4. The postoperative consumption of tramadol, rescue analgesic requirement, and hoarseness, hematoma, signs of local anesthetic toxicity were recorded.ResultsThe consumption of tramadol for PCA at two, six, 12, and 24 hours postoperatively, NRS scores in the recovery room, and the number of patients who used tenoxicam as rescue analgesic were significantly lower in Group 2 than in Group 1. The hemodynamic values were similar between the groups.ConclusionsOur study demonstrates that BSCPB, when applied as a component of multimodal analgesia, is an effective method for reducing the analgesic requirements following thyroid surgery.

A Study to Evaluate the Efficacy of Dexamethasone as an Adjuvant in Ultrasound-Guided Bilateral Superficial Cervical Plexus Block using 0.25% Bupivacaine in Patients Undergoing Thyroid Surgeries under Entropy-Guided General Anesthesia.

Context:Ultrasound-guided bilateral superficial cervical plexus block (BSCPB) is a technique described for thyroid surgeries for postoperative analgesia as the surgery can cause severe pain and discomfort. Perineural dexamethasone is known to prolong analgesic duration and reduce postoperative nausea/vomiting.Aims:To assess the efficacy of dexamethasone as an adjuvant to BSCPB with 0.25% bupivacaine on isoflurane consumption, intraoperative hemodynamic parameters, and postoperative analgesia in patients undergoing thyroid surgeries under general anesthesia.Settings and Design:This was a randomized control trial.Subjects and Methods:Eighty patients were randomized to two equal groups using random number table into Group A with BSCPB receiving 20 mL of 0.25% bupivacaine and Group B with BSCPB receiving 19 mL of 0.25% bupivacaine + injection dexamethasone 4 mg in the preinduction period. Hemodynamic parameters, isoflurane consumption, postoperative visual analog scale (VAS) score, and antiemetic effect over 24 h were compared between two groups.Statistical Analysis Used:Microsoft excel data sheet, Chi-square test, and independent t-test were used for statistical analysis.Results:The intraoperative hemodynamic parameters were comparable between the two groups. There was a significant difference in mean VAS score between two groups from 6 h to 20 h postoperatively. The time of rescue analgesic in Group A was 7.09 ± 1.04 min and Group was 13.19 ± 1.46 min with P < 0.0001. In Group A, 40% had nausea and 35% had vomiting, and in Group B, 7.5% had nausea and 5% had vomiting.Conclusions:Preinduction ultrasound-guided BSCPB with bupivacaine and dexamethasone provides longer duration of postoperative analgesia and lesser nausea and vomiting compared to bupivacaine alone.

Ultrasound-guided bilateral superficial cervical plexus block enhances the quality of recovery of uremia patients with secondary hyperparathyroidism following parathyroidectomy: a randomized controlled trial

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.

Персоніфікований підхід до періопераційного анестезіологічного менеджменту тиреоїдектомій у пацієнтів із синдромом тиреотоксикозу

Актуальність. Робота присвячена вирішенню актуального завдання сучасної тиреоїдної хірургії — поліпшенню результатів хірургічного лікування пацієнтів із синдромом тиреотоксикозу. Мета дослідження — розробити персоніфікований підхід до вибору методу загальної анестезії (ЗА) та періопераційного знеболювання із застосуванням комплексу збалансованої аналгезії та сучасних методів контролю за перебігом анестезії. Матеріали та методи. На першій стадії проведено ретроспективний і проспективний аналіз (2016–2017) 440 випадків і карт пацієнтів з тиреотоксикозом, які перебували на стаціонарному лікуванні з приводу тиреоїдектомії в 2015–2017 рр., для ідентифікації супутньої патології, визначення особливостей загальної анестезії залежно від виду анестезії та її ускладнень. Друга стадія полягала в проспективному дослідженні за участю 175 пацієнтів із тиреотоксикозом після тиреоїдектомії. Результати. Синдром тиреотоксикозу погіршує фізичний статус пацієнта за критеріями Американської асоціації анестезіологів. Як інгаляційна, так і тотальна внутрішньовенна анестезія негативно впливають на показники гемодинаміки та доставку кисню. Встановлено, що поєднана анестезія із білатеральною блокадою поверхневого шийного сплетення на тлі застосування інгаляційної низькопотокової або тотальної внутрішньовенної анестезії забезпечує кращий рівень знеболювання порівняно з моноанестезією. Найкращою антиеметичною схемою є використання ЗА на тлі базової анестезії пропофолом із додаванням метоклопраміду перед індукцією анестезії. Індивідуалізація подання та корекція дози газового або внутрішньовенного анестетиків під контролем BIS­моніторингу дають змогу досягнути персоніфікації загальної анестезії. Найбільш економічно доцільним є використання ІА севофлураном за мінімально­потоковим контуром (FGF = 400 мл/хв). Висновки. Розроблено алгоритм анестезіологічного менеджменту в пацієнтів із синдромом тиреотоксикозу при тиреоїдектоміях із обґрунтуванням використання інгаляційної низькопотокової або тотальної внутрішньовенної анестезії. Отримані нові вірогідні дані дозволили розробити персоніфікований підхід до вибору методу загальної анестезії та періопераційного знеболювання із застосуванням комплексу ЗА та сучасних методів контролю за перебігом анестезії.