Perioperative analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy: a randomized controlled trial

Karakış, Alkan; Tapar, Hakan; Özsoy, Zeki; Suren, Mustafa; Dogru, Serkan; Karaman, Tuğba; Karaman, Serkan; Sahin, Aynur; Kanadlı, Hasan

doi:10.1016/j.bjane.2019.06.012

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Scientific Articles • Rev. Bras. Anestesiol. 69 (5) • Sep-Oct 2019 • https://doi.org/10.1016/j.bjane.2019.06.012 linkcopy

Perioperative analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy: a randomized controlled trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

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 , 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), 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 Superficial cervical plexus block; Thyroidectomy; Anesthesia and analgesia

	Group GS	Group GA	p
Age (year)	49.26 ± 14.70	46.87 ± 14.19	0.602^a a Mann-Whitney U test, p < 0.05.
Gender (F/M)	17/6	15/9	0.401^b b Chi square test.
ASA (I/II)	6/17	9/15	0.401^b b Chi square test.
BMI (kg.m^-2)	26.41 ± 5.18	26.97 ± 6.01	0.949^a a Mann-Whitney U test, p < 0.05.
Smoker (+/-)	6 /17	8/16	0.587^b b Chi square test.
Duration of surgery	140.00 ± 41.76	147.75 ± 38.22	0.268^a a Mann-Whitney U test, p < 0.05.
Duration of anesthesia	154.91 ± 42.00	163.25 ± 37.27	0.212^a a Mann-Whitney U test, p < 0.05.
CL (I/II/III/IV)	13/8/2	13/6/5	0.461^a a Mann-Whitney U test, p < 0.05.
IDS	4.26 ± 1.95	5.33 ± 2.82	0.265^a a Mann-Whitney U test, p < 0.05.
PCS	17.13 ± 8.20	21.41 ± 11.75	0.179^a a Mann-Whitney U test, p < 0.05.

	Group GS	Group GA	p
Tramadol (mg)	91.66 ± 32.5	240.86 ± 74.52	0.01^a a Mann-Whitney U test, p < 0.05.
Paracetamol (g)	2.83 ± 0.75	3.95 ± 1.14	0.002^a a Mann-Whitney U test, p < 0.05.
Remifentanil (mcg)	675 ± 468.77	819.56 ± 535.28	0.009^a a Mann-Whitney U test, p < 0.05.

	Group GS	Group GA	p
Using ondansentron	2 (8%)	11 (45%)	0.004^a a Ki-Kare test, p < 0.05.
Using not ondansentron	21 (92%)	13 (55)	0.004^a a Ki-Kare test, p < 0.05.
Using tramadol	6 (26%)	24	0.000001^a a Ki-Kare test, p < 0.05.
Using not tramadol	17 (74%)	1	0.000001^a a Ki-Kare test, p < 0.05.

	Group GS	Group GA	p
Postoperative 15th min	2.6 ± 0.54	5.62 ± 1.3	<0.01^a a Mann-Whitney U test, p < 0.05.
Postoperative 30th min	2.8 ± 0.44	5.12 ± 0.83	<0.01^a a Mann-Whitney U test, p < 0.05.
Postoperative 1st hour	2.8 ± 0.83	4.12 ± 1.12	<0.01^a a Mann-Whitney U test, p < 0.05.
Postoperative 2nd hour	2.2 ± 0.44	3.62 ± 1.18	<0.01^a a Mann-Whitney U test, p < 0.05.
Postoperative 6th hour	2.2 ± 0.83	2.87 ± 0.83	<0.01^a a Mann-Whitney U test, p < 0.05.
Postoperative 12th hour	1.6 ± 0.54	2.13 ± 0.53	<0.01^a a Mann-Whitney U test, p < 0.05.
Postoperative 24th hour	1.6 ± 0.54	1.87 ± 0.35	0.03^a a Mann-Whitney U test, p < 0.05.
Postoperative 48th hour	1.4 ± 0.54	1.75 ± 1.03	0.622^a a Mann-Whitney U test, p < 0.05.

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Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[TFN6] ASA, American Society of Anaesthesiologist; BMI, body mass index; F, female; M, male; CL, Cormack-Lehane grade; IDS, intubation difficulty scale; PCS, pain catastrophizing scale.

[TFN1] ^a
Mann-Whitney U test, p < 0.05.

[TFN2] ^b
Chi square test.