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Analgesic Efficacy of Bilateral Superficial Cervical Plexus Block in Robot-Assisted Endoscopic Thyroidectomy Using a Transaxillary Approach

World Journal of Surgery volume 36, pages 2831–2837 (2012)Cite this article

Abstract

Background

Nerve blocks and infiltration with local anesthetics are commonly employed methods for postoperative pain control. This prospective, randomized trial was conducted to determine whether bilateral superficial cervical plexus block (BSCPB) is effective for reducing acute postoperative pain after robot-assisted endoscopic thyroidectomy (RAET) and to compare its effects with that of local wound infiltration (LWI).

Methods

Ninety-seven patients who were to undergo RAET were randomly assigned to one of three groups to receive BSCPB with either 20 mL of 0.525 % ropivacaine (BSCPB group, n = 32) or 20 mL of isotonic sodium chloride solution (Control group, n = 32) or LWI with 20 mL of 0.525 % ropivacaine (LWI group, n = 33). Postoperative pain scores were assessed at the postoperative anesthesia care unit (PACU) and at 6, 24, and 48 h postoperatively using a visual analog scale (VAS). Patients with VAS scores of ≥40 were administered rescue analgesics according to a standardized protocol. The main outcome variables were pain scores during the first postoperative 24 h and the number of patients requiring postoperative analgesic rescue.

Results

The BSCBP and LWI groups showed lower pain scores compared with the Control group at the PACU. The BSCPB group continued to show significantly lower pain scores compared with the LWI and Control groups at postoperative 6 and 24 h. The number of patients requiring analgesic rescue at the PACU was lower in the BSCPB and LWI groups than in the Control group. The number of patients requiring additional rescue analgesics after discharge from the PACU until the first 24 postoperative h was lower in the BSCPB group than in the LWI group.

Conclusions

BSCPB and LWI are effective for reducing pain scores and analgesic requirements during the immediate postoperative period in patients who undergo RAET, with BSCPB being superior to LWI at postoperative 6–24 h.

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References

  1. Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875

    PubMed  Article  CAS  Google Scholar 

  2. Ikeda Y, Takami H, Niimi M et al (2001) Endoscopic thyroidectomy by the axillary approach. Surg Endosc 15:1362–1364

    PubMed  Article  CAS  Google Scholar 

  3. Kang SW, Lee SC, Lee SH et al (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146:1048–1055

    PubMed  Article  Google Scholar 

  4. Duncan TD, Rashid Q, Speights F et al (2007) Endoscopic transaxillary approach to the thyroid gland: our early experience. Surg Endosc 21:2166–2171

    PubMed  Article  CAS  Google Scholar 

  5. Ikeda Y, Takami H, Sasaki Y et al (2004) Are there significant benefits of minimally invasive endoscopic thyroidectomy? World J Surg 28:1075–1078. doi:10.1007/s00268-004-7655-2

    PubMed  Article  Google Scholar 

  6. Ikeda Y, Takami H, Sasaki Y et al (2003) Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg 196:189–195

    PubMed  Article  Google Scholar 

  7. Lee J, Nah KY, Kim RM et al (2010) Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc 24:3186–3194

    PubMed  Article  Google Scholar 

  8. Hong JY, Kim WO, Chung WY et al (2010) Paracetamol reduces postoperative pain and rescue analgesic demand after robot-assisted endoscopic thyroidectomy by the transaxillary approach. World J Surg 34:521–526. doi:10.1007/s00268-009-0346-2

    PubMed  Article  Google Scholar 

  9. Kim SY, Jeong JJ, Chung WY et al (2010) Perioperative administration of pregabalin for pain after robot-assisted endoscopic thyroidectomy: a randomized clinical trial. Surg Endosc 24:2776–2781

    PubMed  Article  Google Scholar 

  10. Warschkow R, Tarantino I, Jensen K et al (2012) 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 22:44–52

    PubMed  Article  Google Scholar 

  11. Andrieu G, Amrouni H, Robin E et al (2007) Analgesic efficacy of bilateral superficial cervical plexus block administered before thyroid surgery under general anaesthesia. Br J Anaesth 99:561–566

    PubMed  Article  CAS  Google Scholar 

  12. Dieudonne N, Gomola A, Bonnichon P et al (2001) Prevention of postoperative pain after thyroid surgery: a double-blind randomized study of bilateral superficial cervical plexus blocks. Anesth Analg 92:1538–1542

    PubMed  Article  CAS  Google Scholar 

  13. Steffen T, Warschkow R, Brandle M et al (2010) Randomized controlled trial of bilateral superficial cervical plexus block versus placebo in thyroid surgery. Br J Surg 97:1000–1006

    PubMed  Article  CAS  Google Scholar 

  14. Miyano G, Lobe TE, Wright SK (2008) Bilateral transaxillary endoscopic total thyroidectomy. J Pediatr Surg 43:299–303

    PubMed  Article  Google Scholar 

  15. Cousins MJ, Bridenbaugh PO (2009) Cousins and Bridenbaugh’s neural blockade in clinical anesthesia and pain medicine, 4th edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  16. Bagul A, Taha R, Metcalfe MS et al (2005) Pre-incision infiltration of local anesthetic reduces postoperative pain with no effects on bruising and wound cosmesis after thyroid surgery. Thyroid 15:1245–1248

    PubMed  Article  CAS  Google Scholar 

  17. Gozal Y, Shapira SC, Gozal D et al (1994) Bupivacaine wound infiltration in thyroid surgery reduces postoperative pain and opioid demand. Acta Anaesthesiol Scand 38:813–815

    PubMed  Article  CAS  Google Scholar 

  18. Karamanlioglu B, Turan A, Memis D et al (2005) Infiltration with ropivacaine plus lornoxicam reduces postoperative pain and opioid consumption. Can J Anaesth 52:1047–1053

    PubMed  Article  Google Scholar 

  19. Mottura AA (1995) Local infiltrative anesthesia for transaxillary subpectoral breast implants. Aesthetic Plast Surg 19:37–39

    PubMed  Article  CAS  Google Scholar 

  20. Papaspyrou G, Ferlito A, Silver CE et al (2011) Extracervical approaches to endoscopic thyroid surgery. Surg Endosc 25:995–1003

    PubMed  Article  Google Scholar 

  21. Brogly N, Wattier JM, Andrieu G et al (2008) Gabapentin attenuates late but not early postoperative pain after thyroidectomy with superficial cervical plexus block. Anesth Analg 107:1720–1725

    PubMed  Article  CAS  Google Scholar 

  22. Fassoulaki A, Triga A, Melemeni A et al (2005) Multimodal analgesia with gabapentin and local anesthetics prevents acute and chronic pain after breast surgery for cancer. Anesth Analg 101:1427–1432

    PubMed  Article  CAS  Google Scholar 

  23. Obata H, Saito S, Fujita N et al (1999) Epidural block with mepivacaine before surgery reduces long-term post-thoracotomy pain. Can J Anaesth 46:1127–1132

    PubMed  Article  CAS  Google Scholar 

  24. Hariharan S, Moseley H, Kumar A et al (2009) The effect of preemptive analgesia in postoperative pain relief–a prospective double-blind randomized study. Pain Med 10:49–53

    PubMed  Article  Google Scholar 

  25. Vallejo MC, Phelps AL, Sah N et al (2006) Preemptive analgesia with bupivacaine for segmental mastectomy. Reg Anesth Pain Med 31:227–232

    PubMed  CAS  Google Scholar 

  26. Alessandri F, Lijoi D, Mistrangelo E et al (2006) Effect of presurgical local infiltration of levobupivacaine in the surgical field on postsurgical wound pain in laparoscopic gynecological surgery. Acta Obstet Gynecol Scand 85:844–849

    PubMed  Article  CAS  Google Scholar 

  27. Johansson B, Hallerback B, Stubberod A et al (1997) Preoperative local infiltration with ropivacaine for postoperative pain relief after inguinal hernia repair. A randomised controlled trial. Eur J Surg 163:371–378

    PubMed  CAS  Google Scholar 

  28. Mulroy MF, Burgess FW, Emanuelsson BM (1999) Ropivacaine 0.25% and 0.5%, but not 0.125%, provide effective wound infiltration analgesia after outpatient hernia repair, but with sustained plasma drug levels. Reg Anesth Pain Med 24:136–141

    PubMed  CAS  Google Scholar 

  29. Dahl JB, Moiniche S, Kehlet H (1994) Wound infiltration with local anaesthetics for postoperative pain relief. Acta Anaesthesiol Scand 38:7–14

    PubMed  Article  CAS  Google Scholar 

  30. Ong CK, Lirk P, Seymour RA et al (2005) The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg 100:757–773

    PubMed  Article  Google Scholar 

  31. Kim GH, Ahn HJ, Kim HS et al (2011) Postoperative nausea and vomiting after endoscopic thyroidectomy: total intravenous vs. balanced anesthesia. Korean J Anesthesiol 60:416–421

    PubMed  Article  CAS  Google Scholar 

  32. Leone S, Di Cianni S, Casati A et al (2008) Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine. Acta Biomed 79:92–105

    PubMed  CAS  Google Scholar 

  33. Zink W, Graf BM (2008) The toxicity of local anesthetics: the place of ropivacaine and levobupivacaine. Curr Opin Anaesthesiol 21:645–650

    PubMed  Article  Google Scholar 

  34. Herbland A, Cantini O, Reynier P et al (2006) 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 31:34–39

    PubMed  CAS  Google Scholar 

  35. Pandit JJ, Satya-Krishna R, Gration P (2007) Superficial or deep cervical plexus block for carotid endarterectomy: a systematic review of complications. Br J Anaesth 99:159–169

    PubMed  Article  CAS  Google Scholar 

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Conflict of interest

Drs. Seokyung Shin, Woong Youn Chung, Jong Ju Jeong, Sang-Wook Kang, and Young Jun Oh have no conflicts of interest or financial ties to disclose.

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Affiliations

  1. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea

    Seokyung Shin & Young Jun Oh

  2. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea

    Woung Youn Chung, Jong Ju Jeong & Sang-Wook Kang

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  1. Seokyung Shin
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  2. Woung Youn Chung
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  3. Jong Ju Jeong
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  4. Sang-Wook Kang
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  5. Young Jun Oh
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Correspondence to Young Jun Oh.

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Shin, S., Chung, W.Y., Jeong, J.J. et al. Analgesic Efficacy of Bilateral Superficial Cervical Plexus Block in Robot-Assisted Endoscopic Thyroidectomy Using a Transaxillary Approach. World J Surg 36, 2831–2837 (2012). https://doi.org/10.1007/s00268-012-1780-0

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Keywords

  • Remifentanil
  • Visual Analog Scale Score
  • Ropivacaine
  • Anterior Neck
  • Endoscopic Thyroidectomy