Skip to main content

Advertisement

SpringerLink
Log in

Impact of drains on nausea and vomiting after thyroid and parathyroid surgery: a randomized controlled trial

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Objective

Nausea and vomiting are common side effects following thyroid and parathyroid surgery. In a prospective controlled randomized trial, postoperative nausea and vomiting (PONV) and the number of episodes of vomiting were defined as two primary endpoints. We analysed whether the placement of drains after thyroid or parathyroid surgery enhances PONV and/or influences vomiting.

Patients and methods

From November 2007 to January 2012, 136 consecutive patients were included for thyroid or parathyroid surgery and were randomly assigned to group A (drain, n = 69) or group B (no drain, n = 67). PONV was assessed with visual analogue scale (VAS; range 0 to 10) measurements. Furthermore, episodes of vomiting as well as analgetic and antiemetic therapies were recorded. Difference in neck circumference was compared pre- and postoperatively.

Results

Patients’ characteristics did not differ between group A and B. Postoperative VAS values for pain were 2.4 ± 0.3 (group A) and 2.6 ± 0.2 (group B) (p = 0.62), and for nausea 1.4 ± 0.2 (group A) and 1.1 ± 0.2 (group B) (p = 0.57). The relative occurrences of episodes for postoperative vomiting were equal in both groups 0.3 ± 0.1 (p = 1.0). Antiemetic drugs were administered 37 times (group A) and 18 times (group B) (p = 0.099). The total number of treatments of patients with antiemetic drugs was 23 (33.3%) in group A vs. 13 (19.4%) in group B (p = 0.081). The neck circumference postoperatively was significantly larger in group B (p = 0.0025).

Conclusions

Drains after surgery do not enhance postoperative pain, nausea and vomiting. The placement of drains in thyroid surgery is recommended to avoid relevant fluid collection. Drains however may influence the amount of antiemetic drug requirements.

Trial registration

ClinicalTrials.gov Identifier: NCT01679418

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

BW:

Body weight

i.v.:

Intravenous

POD:

Postoperative day

PONV:

Postoperative nausea and vomiting

RLN:

Recurrent laryngeal nerve

s.c.:

Subcutaneously

SLN:

Superior laryngeal nerve

References

  1. Burkey SH, van Heerden JA, Thompson GB, Grant CS, Schleck CD, Farley DR (2001) Reexploration for symptomatic hematomas after cervical exploration. Surgery 130(6):914–920. https://doi.org/10.1067/msy.2001.118384

    Article  CAS  PubMed  Google Scholar 

  2. Leyre P, Desurmont T, Lacoste L, Odasso C, Bouche G, Beaulieu A, Valagier A, Charalambous C, Gibelin H, Debaene B, Kraimps J-L (2008) Does the risk of compressive hematoma after thyroidectomy authorize 1-day surgery? Langenbecks Arch Surg 393(5):733–737. https://doi.org/10.1007/s00423-008-0362-y

    Article  PubMed  Google Scholar 

  3. Clark OH (1982) Total thyroidectomy - the treatment of choice for patients with differentiated thyroid-cancer. Ann Surg 196(3):361–370. https://doi.org/10.1097/00000658-198209000-00016

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Dralle H, Sekulla C, Lorenz K, Grond S, Irmscher B (2004) Outpatient and short-stay thyroid and parathyroid surgery. Chirurg 75(2):131–143. https://doi.org/10.1007/s00104-003-0775-7

    Article  CAS  PubMed  Google Scholar 

  5. Reeve T, Thompson NW (2000) Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg 24(8):971–975

    Article  CAS  PubMed  Google Scholar 

  6. Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, Pelizzo MR, Pezzullo L (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 28(3):271–276. https://doi.org/10.1007/s00268-003-6903-1

    Article  PubMed  Google Scholar 

  7. Ignjatovic M, Cuk V, Ozegovic A, Cerovic S, Kostic Z, Romic P (2003) Early complications in surgical treatment of thyroid diseases: analysis of 2100 patients (Rane komplikacije operativnog lecenja oboljenja stitaste zlezde: analiza 2100 bolesnika.). Acta chirurgica Iugoslavica 50(3):155–175

    CAS  PubMed  Google Scholar 

  8. Wilhelm T, Metzig A (2011) Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J Surg 35(3):543–551. https://doi.org/10.1007/s00268-010-0846-0

    Article  PubMed  Google Scholar 

  9. Bergamaschi R, Becouarn G, Ronceray J, Arnaud JP (1998) Morbidity of thyroid surgery. Am J Surg 176(1):71–75. https://doi.org/10.1016/s0002-9610(98)00099-3

    Article  CAS  PubMed  Google Scholar 

  10. Hurtado-Lopez LM, Zaldivar-Ramirez FR, Basurto Kuba E, Pulido Cejudo A, Garza Flores JH, Munoz Solis O, Campos Castillo C (2002) Causes for early reintervention after thyroidectomy. Med Sci Monit : international medical journal of experimental and clinical research 8(4):CR247–CR250

    Google Scholar 

  11. Materazzi G, Dionigi G, Berti P, Rago R, Frustaci G, Docimo G, Puccini M, Miccoli P (2007) One-day thyroid surgery: retrospective analysis of safety and patient satisfaction on a consecutive series of 1,571 cases over a three-year period. Eur Surg Res 39(3):182–188. https://doi.org/10.1159/000100904

    Article  CAS  PubMed  Google Scholar 

  12. Ozlem N, Ozdogan M, Gurer A, Gomceli I, Aydin R (2006) Should the thyroid bed be drained after thyroidectomy? Langenbecks Arch Surg 391(3):228–230. https://doi.org/10.1007/s00423-006-0048-2

    Article  PubMed  Google Scholar 

  13. Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ (2009) The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg 52(1):39–44

    PubMed  PubMed Central  Google Scholar 

  14. Ozbas S, Kocak S, Aydintug S, Cakmak A, Demirkiran MA, Wishart GC (2005) Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goitre. Endocr J 52(2):199–205. https://doi.org/10.1507/endocrj.52.199

    Article  PubMed  Google Scholar 

  15. Woods RS, Woods JF, Duignan ES, Timon C (2014) Systematic review and meta-analysis of wound drains after thyroid surgery. Br J Surg 101(5):446–456. https://doi.org/10.1002/bjs.9448

    Article  CAS  PubMed  Google Scholar 

  16. Portinari M, Carcoforo P (2017) The application of drains in thyroid surgery. Gland Surg 6(5):563–573. https://doi.org/10.21037/gs.2017.07.04

    Article  PubMed  PubMed Central  Google Scholar 

  17. Schietroma M, Pessia B, Bianchi Z, De Vita F, Carlei F, Guadagni S, Amicucci G, Clementi M (2017) Thyroid surgery: to drain or not to drain, that is the problem - a randomized clinical trial. ORL J Otorhinolaryngol Relat Spec 79(4):202–211. https://doi.org/10.1159/000464137

    Article  PubMed  Google Scholar 

  18. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N (1999) A simplified risk score for predicting postoperative nausea and vomiting - conclusions from cross-validations between two centers. Anesthesiology 91(3):693–700. https://doi.org/10.1097/00000542-199909000-00022

    Article  CAS  PubMed  Google Scholar 

  19. Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, Zernak C, Danner K, Jokela R, Pocock SJ, Trenkler S, Kredel M, Biedler A, Sessler DI, Roewer N, Investigators I (2004) A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 350(24):2441–2451. https://doi.org/10.1056/NEJMoa032196

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Tramer MR (2001) A rational approach to the control of postoperative nausea and vomiting: evidence from systematic reviews. Part I. Efficacy and harm of antiemetic interventions, and methodological issues. Acta Anaesthesiol Scand 45(1):4–13. https://doi.org/10.1034/j.1399-6576.2001.450102.x

    Article  CAS  PubMed  Google Scholar 

  21. Matsuura H, Inoue S, Kawaguchi M (2016) The risk of postoperative nausea and vomiting between surgical patients received propofol and sevoflurane anesthesia: a matched study. Acta Anaesthesiol Taiwanica 54(4):114–120. https://doi.org/10.1016/j.aat.2016.09.002

    Article  Google Scholar 

  22. Thompson DP, Ashley FL (1978) Face-lift complications - study of 922 cases performed in a 6-year period. Plast Reconstr Surg 61(1):40–49. https://doi.org/10.1097/00006534-197801000-00008

    Article  CAS  PubMed  Google Scholar 

  23. Sonner JM, Hynson JM, Clark O, Katz JA (1997) Nausea and vomiting following thyroid and parathyroid surgery. J Clin Anesth 9(5):398–402

    Article  CAS  PubMed  Google Scholar 

  24. Fujii Y, Saitoh Y, Tanaka H, Toyooka H (1998) Prophylactic antiemetic therapy with granisetron in women undergoing thyroidectomy. Br J Anaesth 81(4):526–528

    Article  CAS  PubMed  Google Scholar 

  25. Apfel CC, Kranke P, Eberhart LHJ (2004) Comparison of surgical site and patient’s history with a simplified risk score for the prediction of postoperative nausea and vomiting. Anaesthesia 59(11):1078–1082. https://doi.org/10.1111/j.1365-2044.2004.03875.x

    Article  CAS  PubMed  Google Scholar 

  26. Shaha AR, Jaffe BM (1994) Practical management of post-thyroidectomy hematoma. J Surg Oncol 57(4):235–238. https://doi.org/10.1002/jso.2930570406

    Article  CAS  PubMed  Google Scholar 

  27. Samraj K, Gurusamy KS (2007) Wound drains following thyroid surgery. Cochrane Database Syst Rev (4). doi:https://doi.org/10.1002/14651858.CD006099.pub2

  28. Schoretsanitis G, Melissas J, Sanidas E, Christodoulakis M, Vlachonikolis JG, Tsiftsis DD (1998) Does draining the neck affect morbidity following thyroid surgery? Am Surg 64(8):778–780

    CAS  PubMed  Google Scholar 

  29. Probst P, Zaschke S, Heger P, Harnoss JC, Huttner FJ, Mihaljevic AL, Knebel P, Diener MK (2019) Evidence-based recommendations for blinding in surgical trials. Langenbeck’s Arch Surg:Deutsche Gesellschaft fur Chirurgie 404(3):273–284. https://doi.org/10.1007/s00423-019-01761-6

    Article  Google Scholar 

  30. Suzuki T, Kurazumi T, Ueda T, Nagata H, Yamada T, Kosugi S, Hashiguchi S, Ito K, Morisaki H (2017) Desflurane anesthesia worsens emergence agitation in adult patients undergoing thyroid surgery compared to sevoflurane anesthesia. JA Clin Rep 3(1):36. https://doi.org/10.1186/s40981-017-0106-5

    Article  PubMed  PubMed Central  Google Scholar 

  31. Fujii Y (2008) The benefits and risks of different therapies in preventing postoperative nausea and vomiting in patients undergoing thyroid surgery. Curr Drug Saf 3(1):27–34. https://doi.org/10.2174/157488608783333934

    Article  CAS  PubMed  Google Scholar 

  32. Won YJ, Yoo JY, Chae YJ, Kim DH, Park SK, Ch HB, Kim IS, Lee JH, Lee SY (2011) The incidence of postoperative nausea and vomiting after thyroidectomy using three anaesthetic techniques. J Int Med Res 39(5):1834–1842

    Article  CAS  PubMed  Google Scholar 

  33. Colak T, Akca T, Turkmenoglu O, Canbaz H, Ustunsoy B, Kanik A, Aydin S (2008) Drainage after total thyroidectomy or lobectomy for benign thyroidal disorders. Journal of Zhejiang University-Science B 9(4):319–323. https://doi.org/10.1631/jzus.B0720257

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sozen S, Topuz O, Tukenmez M, Keceli M (2011) The use of fibrin sealant after total thyroidectomy for benign disease obviates the need for routine drainage. Results of a randomized controlled trial. Hippokratia 15(3):247–251

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Amir I, Morar P, Belloso A (2010) Postoperative drainage in head and neck surgery. Ann R Coll Surg Engl 92(8):651–654. https://doi.org/10.1308/003588410x12699663904754

    Article  PubMed  PubMed Central  Google Scholar 

  36. Prichard RS, Murphy R, Lowry A, McLaughlin R, Malone C, Kerin MJ (2010) The routine use of post-operative drains in thyroid surgery: an outdated concept. Ir Med J 103(1):26–27

    CAS  PubMed  Google Scholar 

  37. Ssenyondo KE, Fualal J, Jombwe J, Galukande M (2013) To drain or not to drain after thyroid surgery: a randomized controlled trial at a tertiary hospital in East Africa. Afr Health Sci 13(3):748–755. https://doi.org/10.4314/ahs.v13i3.33

    Article  Google Scholar 

  38. Deveci U, Altintoprak F, Sertan Kapakli M, Manukyan MN, Cubuk R, Yener N, Kebudi A (2013) Is the use of a drain for thyroid surgery realistic? A prospective randomized interventional study. J Thyroid Res 2013:285768. https://doi.org/10.1155/2013/285768

    Article  PubMed  PubMed Central  Google Scholar 

  39. Memon ZA, Ahmed G, Khan SR, Khalid M, Sultan N (2012) Postoperative use of drain in thyroid lobectomy - a randomized clinical trial conducted at Civil Hospital, Karachi, Pakistan. Thyroid Res 5(1):9–9. https://doi.org/10.1186/1756-6614-5-9

    Article  PubMed  PubMed Central  Google Scholar 

  40. Li L, Liu W, Tao H, Chen H, Li W, Huang T, Zhao E (2018) Efficacy and safety of negative pressure versus natural drainage after thyroid surgery: a systematic review and meta-analysis. Medicine (Baltimore) 97(31):e11576. https://doi.org/10.1097/MD.0000000000011576

    Article  Google Scholar 

  41. Lu IC, Lin IH, Wu CW, Chen HY, Lin YC, Chiang FY, Chang PY (2017) Preoperative, intraoperative and postoperative anesthetic prospective for thyroid surgery: what’s new. Gland Surg 6(5):469–475. https://doi.org/10.21037/gs.2017.05.02

    Article  PubMed  PubMed Central  Google Scholar 

  42. Kim SY, Kim EM, Nam K-H, Chang DJ, Nam SH, Kim KJ (2008) Postoperative intravenous patient-controlled analgesia in thyroid surgery: comparison of fentanyl and ondansetron regimens with and without the nonsteriodal anti-inflammatory drug ketorolac. Thyroid 18(12):1285–1290. https://doi.org/10.1089/thy.2008.0007

    Article  CAS  PubMed  Google Scholar 

  43. Lee SW, Choi EC, Lee YM, Lee JY, Kim SC, Koh YW (2006) Is lack of placement of drains after thyroidectomy with central neck dissection safe? A prospective, randomized study. Laryngoscope 116(9):1632–1635. https://doi.org/10.1097/01.mlg.0000231314.86486.be

    Article  PubMed  Google Scholar 

  44. Piromchai P, Vatanasapt P, Reechaipichitkul W, Phuttharak W, Thanaviratananich S (2008) Is the routine pressure dressing after thyroidectomy necessary? A prospective randomized controlled study. BMC ear, nose, and throat disorders 8:1–1. https://doi.org/10.1186/1472-6815-8-1

    Article  PubMed  PubMed Central  Google Scholar 

  45. Khanna J, Mohil RS, Chintamani, Bhatnagar D, Mittal MK, Sahoo M, Mehrotra M (2005) Is the routine drainage after surgery for thyroid necessary? A prospective randomized clinical study ISRCTN63623153. BMC Surg 5:11–11. https://doi.org/10.1186/1471-2482-5-11

    Article  PubMed  PubMed Central  Google Scholar 

  46. Abboud B, Sleilaty G, Rizk H, Abadjian G, Ghorra C (2012) Safety of thyroidectomy and cervical neck dissection without drains. Can J Surg 55(3):199–203. https://doi.org/10.1503/cjs.025710

    Article  PubMed  PubMed Central  Google Scholar 

  47. Williams J, Toews D, Prince M (2003) Survey of the use of suction drains in head and neck surgery and analysis of their biomechanical properties. J Otolaryngol 32(1):16–22. https://doi.org/10.2310/7070.2003.35365

    Article  PubMed  Google Scholar 

  48. Specht MC, Romero M, Barden CB, Esposito C, Fahey TJ (2001) Characteristics of patients having thyroid surgery under regional anesthesia. J Am Coll Surg 193(4):367–372. https://doi.org/10.1016/s1072-7515(01)01048-1

    Article  CAS  PubMed  Google Scholar 

  49. Apfel CC, Stoecklein K, Lipfert P (2005) PONV: a problem of inhalational anaesthesia? Best Pract Res Clin Anaesthesiol 19(3):485–500. https://doi.org/10.1016/j.bpa.2005.03.001

    Article  CAS  PubMed  Google Scholar 

  50. White PF, Watcha MF (1993) Are new drugs cost-effective for patients undergoing ambulatory surgery. Anesthesiology 78(1):2–5. https://doi.org/10.1097/00000542-199301000-00002

    Article  CAS  PubMed  Google Scholar 

  51. Watcha MF, White PF (1992) Postoperative nausea and vomiting - its etiology, treatment, and prevention. Anesthesiology 77(1):162–184. https://doi.org/10.1097/00000542-199207000-00023

    Article  CAS  PubMed  Google Scholar 

  52. Tarantino I, Warschkow R, Beutner U, Kolb W, Luthi A, Luthi C, Schmied BM, Clerici T (2015) Efficacy of a single preoperative dexamethasone dose to prevent nausea and vomiting after thyroidectomy (the tPONV study): a randomized, double-blind, placebo-controlled clinical trial. Ann Surg 262(6):934–940. https://doi.org/10.1097/SLA.0000000000001112

    Article  PubMed  Google Scholar 

  53. Worni M, Schudel HH, Seifert E, Inglin R, Hagemann M, Vorburger SA, Candinas D (2008) Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function. Ann Surg 248(6):1060–1066. https://doi.org/10.1097/SLA.0b013e31818c709a

    Article  PubMed  Google Scholar 

  54. Henzi I, Walder B, Tramer MR (2000) Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 90(1):186–194. https://doi.org/10.1097/00000539-200001000-00038

    Article  CAS  PubMed  Google Scholar 

  55. Lee MJ, Lee KC, Kim HY, Lee WS, Seo WJ, Lee C (2015) Comparison of ramosetron plus dexamethasone with ramosetron alone on postoperative nausea, vomiting, shivering and pain after thyroid surgery. Korean J Pain 28(1):39–44. https://doi.org/10.3344/kjp.2015.28.1.39

    Article  PubMed  PubMed Central  Google Scholar 

  56. Zhang H, Lu J, Wu Q, Wu B, Xu C, Fan Y, Zhou Q (2019) A perioperative small dose of dexamethasone enhances postoperative recovery by reducing volume and inflammatory contents in wound drainage after thyroid surgery: a double-blinded, randomized, prospective study. World J Surg 43:1721–1727. https://doi.org/10.1007/s00268-019-04986-0

    Article  PubMed  Google Scholar 

  57. Wang JJ, Ho ST, Lee SC, Liu YC, Liu YH, Liao YC (1999) The prophylactic effect of dexamethasone on postoperative nausea and vomiting in women undergoing thyroidectomy: a comparison of droperidol with saline. Anesth Analg 89(1):200–203. https://doi.org/10.1097/00000539-199907000-00036

    Article  CAS  PubMed  Google Scholar 

  58. Fujii Y, Nakayama M (2007) Efficacy of dexamethasone for reducing postoperative nausea and vomiting and analgesic requirements after thyroidectomy. Otolaryngol Head Neck Surg 136(2):274–277. https://doi.org/10.1016/j.otohns.2006.09.013

    Article  PubMed  Google Scholar 

  59. Fujii Y, Tanaka H, Kobayashi N (2000) Granisetron/dexamethasone combination for the prevention of postoperative nausea and vomiting after thyroidectomy. Anaesth Intensive Care 28(3):266–269

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Hospital of Baselland, Affiliated with the University of Basel, Liestal, Switzerland

    B. M. Künzli, M. Walensi, J. Wilimsky, C. Bucher, T. Bührer, C. Kull & C. A. Maurer

  2. Department of Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany

    B. M. Künzli

  3. Department of Surgery, HIRSLANDEN Private Hospital Group, Klinik Beau-Site, Schänzlihalde 1, CH - 3013, Bern, Switzerland

    A. Zuse & C. A. Maurer

Authors
  1. B. M. Künzli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Walensi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Wilimsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Bucher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Bührer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Kull
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Zuse
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C. A. Maurer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

BMK participated in the study concept and design, analysis and interpretation of data, and drafting manuscript. JW, CB, and TB participated in the acquisition of data and analysis and interpretation of data. MW and CK participated in the critical revision of the manuscript. AZ participated in the critical revision of manuscript and statistics. CAM participated in the study conception and design, and critical revision of the manuscript.

Corresponding author

Correspondence to C. A. Maurer.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Künzli, B.M., Walensi, M., Wilimsky, J. et al. Impact of drains on nausea and vomiting after thyroid and parathyroid surgery: a randomized controlled trial. Langenbecks Arch Surg 404, 693–701 (2019). https://doi.org/10.1007/s00423-019-01799-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-019-01799-6

Keywords

Search

Navigation