Perioperative analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy: a randomized controlled trial
Eficácia analgésica perioperatória do bloqueio bilateral do plexo cervical superficial em pacientes submetidos à tireoidectomia: estudo clínico randomizado
Alkan Karakış, Hakan Tapar, Zeki Özsoy, Mustafa Suren, Serkan Dogru, Tuğba Karaman, Serkan Karaman, Aynur Sahin, Hasan Kanadlı
Abstract
Introduction
Bilateral Superficial Cervical Plexus Block (BSCPB) is a common method used for analgesia in thyroid surgery. We investigated the analgesic efficacy of bilateral superficial cervical plexus block in the intraoperative and postoperative periods.
Materials and methods
Patients (n = 46) undergoing thyroidectomy were randomly separated into the following 2 groups: the General Anesthesia Group (GA; n = 23) and the general anesthesia plus BSCPB Group (GS; n = 23). The intraoperative analgesic requirement (remifentanil) and Visual Analog Scale (VAS) score at multiple time points during the postoperative period (after extubation, at 15 and 30 minutes and 1, 2, 6, 12, 24 and 48 hours post operation) were evaluated. Total tramadol and paracetamol consumption as well as the amount of ondansetron used was recorded.
Results
The intraoperative remifentanil requirement was significantly lower in the GS Group than in the GA Group (p = 0.009). The postoperative pain scores were significantly lower in the GS Group than in the GA Group at 15 (p < 0.01) and 30 (p < 0.01) minutes and 1 (p < 0.01), 2 (p < 0.01), 6 (p < 0.01), 12 (p < 0.01) and 24 (p = 0.03) hours. The postoperative tramadol requirement was significantly lower in the GS Group than in the GA Group (p = 0.01). The number of patients that used ondansetron was significantly lower in the GS Group than in the GA Group (p = 0.004).
Conclusion
We concluded that BSCPB with 0.25% bupivacaine reduces the postoperative pain intensity and opioid dependency in thyroid surgery patients.
Keywords
Resumo
Introdução
O bloqueio bilateral do plexo cervical superficial (BPCS) é um método comumente usado para analgesia em tireoidectomia. Avaliamos a eficácia analgésica do bloqueio bilateral do BPCS nos períodos intraoperatório e pós‐operatório.
Materiais e métodos
Os pacientes (n = 46) submetidos à tireoidectomia foram randomicamente separados em dois grupos para receber anestesia geral (Grupo GA; n = 23) e anestesia geral mais bloqueio bilateral do BPCS (Grupo GS; n = 23). Avaliamos a necessidade de analgésico no intraoperatório (remifentanil) e os escores VAS (Visual Analog Scale) em vários momentos no pós‐operatório (após a extubação, aos 15 e 30 minutos e em 1, 2, 6, 12, 24 e 48 horas de pós‐operatório). O consumo total de tramadol e paracetamol e a quantidade usada de ondansetrona foram registrados.
Resultados
A necessidade de remifentanil no intraoperatório foi significativamente menor no Grupo GS do que no Grupo GA (p = 0,009). Os escores de dor pós‐operatória foram significativamente menores no Grupo GS do que no grupo GA aos 15 (p < 0,01) e 30 (p < 0,01) minutos e em 1 (p < 0,01), 2 (p < 0,01), 6 (p < 0,01), 12 (p < 0,01) e 24 (p = 0,03) horas de pós‐operatório. A necessidade de tramadol no pós‐operatório foi significativamente menor no Grupo GS do que no grupo GA (p = 0,01). O número de pacientes que recebeu ondansetrona foi significativamente menor no Grupo GS do que no Grupo GA (p = 0,004).
Conclusão
O bloqueio bilateral do BPCS com bupivacaína a 0,25% reduz a intensidade da dor pós‐operatória e a dependência de opioides em pacientes submetidos à tireoidectomia.
Palavras-chave
References
1 Y. Gozal, S.C. Shapira, D. Gozal, F. Magora Bupivacaine wound infiltration in thyroid surgery reduces postoperative pain and opioid demand Acta Anaesthesiol Scand., 38 (1994), pp. 813-815
2 V.S. Karthikeyan, S.C. Sistla, A.S. Badhe, et al. Randomized controlled trial on the efficacy of bilatteral superficial cervical plexus bloc in thyroidectomy Pain Practise., 13 (2013), pp. 539-546
3 Y. Su, Z. Zhang, Q. Zhang, Y. Zhang, Z. Liu Analgesic efficacy of bilateral superficial and deep cervical plexus block in patients with secondary hyperparathyroidism due to chronic renal failure Ann Surg Treat Res., 89 (2015), pp. 325-329
4 K.H. Kang, B.S. Kim, H. Kang The benefits of preincision ropivacaine infiltration for reducing postoperative pain after robotic bilateral axillo‐breast approach thyroidectomy: a prospective, randomized, double‐blind, placebo‐controlled study Ann Surg Treat Res., 88 (2015), pp. 193-199
5 S.M. Klein, R.A. Greengraas, S.M. Steele, et al. A comparision of 0, 5% ropivacaine and 0, 75% ropivacaine for interscalene brachial plexus block Anesth Analg., 87 (1998), pp. 1316-1319
6 S. Mukhopadhyay, M. Niyogi, M. Dutta, et al. 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., 5 (2012), pp. 1-7
7 G. Andrieu, H. Amroni, E. Robin, et al. Analgesic efficacy of bilateral superficial cervical plexus block administered before thyroid surgery under general anaesthesia Br J Anaesth., 99 (2007), pp. 561-566
8 N. Dieudonne, A. Gomola, P. Bonnichon, M.O. Yves Prevention of postoperative pain after thyroid surgery: A double‐blind randomized study of bilateral cervical plexus blocks Anesth Analg., 92 (2001), pp. 1538-1542
9 T. Steffen, R. Warschkow, M. Brändle, I. Tarantino, T. Clerici Randomized controlled trial of bilateral superficial cervical plexus block versus placebo in thyroid surgery Br J Surg., 97 (2010), pp. 1000-1006
10 Z. Eti, P. Irmak, B.M. Gulluoglu, M.N. Manukyan, F.Y. Gogus Does bilateral superficial cervical plexus block decrease analgesic requirement after thyroid surgery? Anesth Analg., 102 (2006), pp. 1174-1176
11 A. Herbland, O. Cantini, P. Reynier, et al. The bilateral superficial cervical plexus block with 0.75% ropivacaine administrated before or after surgery does not prevent postoperative pain after total thyroidectomy Reg Anesth Pain Med., 31 (2006), pp. 31-39
12 J.M. Sonner, J.M. Hynson, O. Clark, J.A. Katz Nausea and vomiting following thyroid and parathyroid surgery J Clin Anesth., 9 (1997), pp. 398-402
13 R.C. Heel, R.N. Brogden, G.E. Pakes, T.M. Speight, G.S. Avery Nefopam: a review of its pharmacological properties and therapeutic efficacy Drugs., 19 (1980), pp. 249-267
14 S.Z. Zhao, F. Chung, D.B. Hanna, et al. Dose–response relationship between opioid use and adverse effects after ambulatory surgery J Pain Symptom Manage., 28 (2004), pp. 35-46
15 P.S. Myles, D.L. Williams, M. Hendrata, H. Anderson, A.M. Weeks Patient satisfaction after anesthesia and surgery Br J Anaesth., 84 (2000), pp. 6-10
16 L.M. Kalmovich, V. Cote, N. Sands, et al. Thyroidectomy: exactly how painful is it? J Otolaryngol Head Neck Surg., 39 (2010), pp. 277-283
17 S. Kale, S. Aqqarwal, V. Shastri Evaluation of the analgesic effect of bilateral superficial cervical plexus block for thyroid surgery: a comparison of pre surgical with post surgical block Indian J Surg., 77 (2015), pp. 1196-1200
18 Y. Gürkan, Z. Taş, K. Toker Ultrasound guided bilateral cervical plexus block reduces postoperative opioid consumption following thyroid surgery J Clin Monit Comput., 29 (2015), pp. 579-584
19 M.L. Shih, Q.Y. Duh, C.B. Hsieh, Y.C. Liu, C.H. Lu, C.S. Wong, et al. Bilateral superficial cervical plexus block combined with general anesthesia administered in thyroid operations World J Surg., 34 (2010), pp. 2338-2343
20 Z.T. Tekgül, M. Gönüllü, E. Şimşek, S. Karaaslan Retrospective evaluation of the efficacy of superficial cervical block on the postoperative use of tramadol in thyroid surgery under general anesthesia Türkiye Klinikleri J Med Sci., 32 (2012), pp. 394-398
21 R. Daour Thyroidectomie sans drainage Chirurgie., 12 (1997), pp. 408-410
22 Z. Alanoğlu, I.G. İltar, H. Eyigün, N. Çanakçı The effects of sevoflurane, isoflurane and total intravenous anesthesia with propofol on postoperative nause and vomiting in trioidectomy surgery Turkiye Klinikleri J Med Sci., 23 (2003), pp. 378-385
23 H.D. Cai, C.Z. Lin, C.X. Yu, X.Z. Lin Bilateral superficial cervical plexus block reduces postoperative nausea and vomiting and early postoperative pain after thyroidectomy J Int Med Res., 40 (2012), pp. 1390-1398
24 M. Suren, I. Okan, A.M. Gokbakan, et al. Factors associated with the pain catastrophizing scale and validation in a sample of the Turkish population Turk J med Sci., 44 (2014), pp. 104-108
25 M. Suren, Z. Kaya, M. Gokbakan, et al. The role of pain catastrophizing score in the prediction of veni puncture pain severity Pain Pract., 14 (2014), pp. 245-251
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email