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Ultrasound guided bilateral cervical plexus block reduces postoperative opioid consumption following thyroid surgery

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Abstract

Thyroid surgery may cause severe postoperative pain and discomfort for patients. Superficial cervical plexus block (SCPB) is one of the regional anesthesia techniques that can provide postoperative analgesia for thyroid surgery. The purpose of this study was to evaluate analgesic effect of ultrasound (US) guided SCPB in patients undergoing thyroid surgery. Fifty ASA I–II patients, aged 20–60, were included in this single blinded study. In a randomized and prospective manner patients were allocated to either SCPB or control group. Bilateral SCPB was performed preoperatively under US guidance using 10 ml 0.25 % bupivacaine for each side. Postoperative analgesia was provided with patient-controlled analgesia method with morphine intravenous. Primary outcome measure was postoperative opioid consumption and analyzed using Mann–Whitney U test. Secondary outcome measures were comparison of opioid side effects like nausea and vomiting and analyzed using Chi square test. VAS scores for pain at postoperative 1st, 6th, 12th, and 24th h were similar in SCPB and control groups (Median VAS values were 2.5, 3, 2, 0 and 3.5, 3, 2, 0 respectively). Postoperative morphine consumption was lower in SCPB group compared to control group at postoperative 6th, 12th, and 24th h (Median doses of morphine consumption were 4, 8, 9 and 5, 9, 11 mg respectively) (P < 0.05). Eight patients in the control group and six patients in the SCBP group had vomiting. Seven patients in the SCPB and none in the control group had hoarseness. Our study has shown that US guided SCPB has a significant analgesic effect in patients undergoing thyroid surgery. Further studies are required to search for the optimal LA dose during US guided SCPB.

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References

  1. Suh YJ, Kim YS, In JH, Joo JD, Jeon YS, Kim HK. Comparison of analgesic efficacy between bilateral superficial and combined (superficial and deep) cervical plexus block administered before thyroid surgery. Eur J Anaesthesiol. 2009;26:1043–7.

    Article  CAS  PubMed  Google Scholar 

  2. Eti Z, Irmak P, Gulluoglu BM, Manukyan MN, Gogus FY. Does bilateral superficial cervical plexus block decrease analgesic requirement after thyroid surgery? Anesth Analg. 2006;102:1174–6.

    Article  PubMed  Google Scholar 

  3. Herbland A, Cantini O, Reynier P, Valat P, Jougon J, Arimone Y, Janvier G. The bilateral superficial cervical plexus block with 0.75% ropivacaine administered before or after surgery does not prevent postoperative pain after total thyroidectomy. Reg Anesth Pain Med. 2006;31:34–9.

    Article  CAS  PubMed  Google Scholar 

  4. Kesisoglou I, Papavramidis TS, Michalopoulos N, Ioannidis K, Trikoupi A, Sapalidis K, Papavramidis ST. Superficial selective cervical plexus block following total thyroidectomy: a randomized trial. Head Neck. 2010;32:984–8.

    Article  PubMed  Google Scholar 

  5. Shih ML, Duh QY, Hsieh CB, Liu YC, Lu CH, Wong CS, Yu JC, Yeh CC. Bilateral superficial cervical plexus block combined with general anesthesia administered in thyroid operations. World J Surg. 2010;34:2338–43.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Karthikeyan VS, Sistla SC, Badhe AS, Mahalakshmy T, Rajkumar N, Ali SM, Gopalakrishnan S. Randomized controlled trial on the efficacy of bilateral superficial cervical plexus block in thyroidectomy. Pain Pract. 2012;13:539–46.

    Article  PubMed  Google Scholar 

  7. Mukhopadhyay S, Niyogi M, Dutta M, Ray R, Gayen GC, Mukherjee M, Mukhopadhyay BS. Bilateral superficial cervical plexus block with or without low-dose intravenous ketamine analgesia: effective, simple, safe, and cheap alternative to conventional general anesthesia for selected neck surgeries. Local Reg Anesth. 2012;5:1–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Antonakakis JG, Ting PH, Sites B. Ultrasound-guided regional anesthesia for peripheral nerve blocks: an evidence-based outcome review. Anesthesiol Clin. 2011;29:179–91.

    Article  PubMed  Google Scholar 

  9. Liu SS, Ngeow J, John RS. Evidence basis for ultrasound-guided block characteristics: onset, quality, and duration. Reg Anesth Pain Med. 2010;35(2 Suppl):S26–35.

    Article  PubMed  Google Scholar 

  10. Doig GS, Simpson F. Randomization and allocation concealment: a practical guide for researchers. J Crit Care. 2005;20:187–93.

    Article  PubMed  Google Scholar 

  11. Hadzic A, editor. Ultrasound-guided cervical plexus block. In: Hadzic’s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia. 2nd ed. New York: Mc-Graw Hill; 2012. p. 345–351.

  12. Weintraud M, Marhofer P, Bösenberg A, Kapral S, Willschke H, Felfernig M, Kettner S. Ilioinguinal/iliohypogastric blocks in children: where do we administer the local anesthetic without direct visualization? Anesth Analg. 2008;106:89–93.

    Article  CAS  PubMed  Google Scholar 

  13. Willschke H, Bosenberg A, Marhofer P, Johnston S, Kettner S, Eichenberger U, Wanzel O, Kapral S. Ultrasonographic guided ilioinguinal/iliohypogastric nerve block in pediatric anesthesia: what is the optimal volume? Anesth Analg. 2006;102:1680–4.

    Article  CAS  PubMed  Google Scholar 

  14. Willschke H, Marhofer P, Bosenberg A, Johnston S, Wanzel O, Cox SG, Sitzwohl C, Kapral S. Ultrasonography for ilioinguinal/iliohypogastric nerve blocks in children. Br J Anaesth. 2005;95:226–30.

    Article  CAS  PubMed  Google Scholar 

  15. Koscielniak-Nielsen ZJ. Ultrasound-guided peripheral nerve blocks: what are the benefits? Acta Anaesthesiol Scand. 2008;52:727–37.

    Article  CAS  PubMed  Google Scholar 

  16. Riazi S, Carmichael N, Awad I, Holtby RM, McCartney CJ. Effect of local anaesthetic volume (20 vs 5 ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. Br J Anaesth. 2008;101(4):549–56.

    Article  CAS  PubMed  Google Scholar 

  17. Marhofer P, Harrop-Griffiths W, Willschke H, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: part 2-recent developments in block techniques. Br J Anaesth. 2010;104:673–83.

    Article  CAS  PubMed  Google Scholar 

  18. Egan RJ, Hopkins JC, Beamish AJ, Shah R, Edwards AG, Morgan JD. Randomized clinical trial of intraoperative superficial cervical plexus block versus incisional local anaesthesia in thyroid and parathyroid surgery. Br J Surg. 2013;100:1732–8.

    Article  CAS  PubMed  Google Scholar 

  19. Dieudonne N, Gomola A, Bonnichon P, Ozier YM. Prevention of postoperative pain after thyroid surgery: a double-blind randomized study of bilateral superficial cervical plexus blocks. Anesth Analg. 2001;92:1538–42.

    Article  CAS  PubMed  Google Scholar 

  20. Steffen T, Warschkow R, Brändle M, Tarantino I, Clerici T. Randomized controlled trial of bilateral superficial cervical plexus block versus placebo in thyroid surgery. Br J Surg. 2010;97:1000–6.

    Article  CAS  PubMed  Google Scholar 

  21. Guay J, Grabs D. A cadaver study to determine the minimum volume of methylene blue or black naphthol required to completely color the nerves relevant for anesthesia during breast surgery. Clin Anat. 2011;24:202–8.

    Article  PubMed  Google Scholar 

  22. Umbrain VJ, van Gorp VL, Schmedding E, Debing EE, von Kemp K, Van den Brande PM, Camu F. Ropivacaine 3.75 mg/ml, 5 mg/ml, or 7.5 mg/ml for cervical plexus block during carotid endarterectomy. Reg Anesth Pain Med. 2004;29:312–6.

    Article  CAS  PubMed  Google Scholar 

  23. Warschkow R, Tarantino I, Jensen K, Beutner U, Clerici T, Schmied BM, Steffen T. Bilateral superficial cervical plexus block in combination with general anesthesia has a low efficacy in thyroid surgery: a meta-analysis of randomized controlled trials. Thyroid. 2012;22:44–52.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Kocaeli Üniversitesi Tıp Fakültesi Hastanesi, Umuttepe Kampüsü, 41380, Kocaeli, Turkey

    Yavuz Gürkan, Zafer Taş, Kamil Toker & Mine Solak

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  1. Yavuz Gürkan
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  2. Zafer Taş
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  3. Kamil Toker
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  4. Mine Solak
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Correspondence to Yavuz Gürkan.

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Gürkan, Y., Taş, Z., Toker, K. et al. Ultrasound guided bilateral cervical plexus block reduces postoperative opioid consumption following thyroid surgery. J Clin Monit Comput 29, 579–584 (2015). https://doi.org/10.1007/s10877-014-9635-x

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  • DOI: https://doi.org/10.1007/s10877-014-9635-x

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