Comparison of ultrasound-guided intermediate vs subcutaneous cervical plexus block for postoperative analgesia in patients undergoing total thyroidectomy: A randomised double-blind trial

Kartik Syal, Ankita Chandel, Avinash Goyal, Arunima Sharma, Kartik Syal, Ankita Chandel, Avinash Goyal, Arunima Sharma

Abstract

Background and aims: Intermediate cervical plexus block (CPB) is a new procedure whose analgesic efficacy compared to superficial cervical plexus block is yet to be established. We compared the analgesic efficacy of superficial vs intermediate CPB for post-operative analgesia after thyroid surgery.

Methods: Forty-five patients with American Society of Anaesthesiologists' physical status 1 or 2 undergoing total thyroidectomy were recruited. Forty-four patients in superficial/subcutaneous CPB group (n = 22) and intermediate CPB (n = 22) received 20 mL 0.25% bupivacaine with adrenaline 100 μg bilaterally in ultrasound-guided superficial and intermediate cervical plexus block before induction of general anaesthesia., respectively. The primary outcome measure was the postoperative visual analogue scale (VAS) scores at 0, 2, 4, 6, 12 and 24. Secondary outcome measures included the total dose of rescue analgesic required, duration of postoperative analgesia and patient's satisfaction score. Statistical analysis was with the Mann-Whitney U test and independent t-test.

Results: The post-operative VAS scores were lower in intermediate CPB group compared to superficial CPB group at 2, 4, 6, 12, 18 and 24 h [P < 0.05]. Time tofirst rescue analgesic demand was prolonged 10.06 ± 3.62 h in intermediate group compared to 7.94 ± 3.62 h in superficial group [P = 0.017] and total analgesic consumption were lower in intermediate group (71.25 ± 16.70 μg) than the superficial group (101.25 ± 50.31 μg) [P = 0.011].

Conclusion: Ultrasound-guided intermediate CPB reduces post-operative pain scores, prolongs duration of analgesia and decreases demands for rescue analgesia compared to superficial CPB.

Keywords: Anaesthesia; analgesia; pain; postoperative; thyroidectomy.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2020 Indian Journal of Anaesthesia.

Figures

Figure 1
Figure 1
Flowchart of patients recruited and analyzed in the study
Figure 2
Figure 2
Ultrasound guided superficial cervical plexus block showing spread of injectate above the investing fascia
Figure 3
Figure 3
Ultrasound guided intermediate cervical plexus block showing spread of injectate below the investing fascia

References

    1. Suresh S, Barcelona SL, Young NM, Seligman I, Heffner CL, Coté CJ. Postoperative pain relief in children undergoing tympanomastoid surgery: Is a regional block better than opioids? Anesth Analg. 2002;94:859–62.
    1. Mariappan R, Mehta J, Massicotte E, Nagappa M, Manninen P, Venkatraghavan L. Effect of superficial cervical plexus block on postoperative quality of recovery after anterior cervical discectomy and fusion: A randomized controlled trial. Can J Anaesth. 2015;62:883–90.
    1. Hardy D. Relief of pain in acute herpes zoster by nerve blocks and possible prevention of post-herpetic neuralgia. Can J Anaesth. 2005;52:186–90.
    1. Burns A. Observations on the Surgical Anatomy of the Head and Neck: Illustrated by Cases and Engravings. Glasgow: Wardlaw & Cunninghame; 1824. pp. 1851–991.
    1. Guidera AK, Dawes PJ, Fong A, Stringer MD. Head and neck fascia and compartments: No space for spaces. Head Neck. 2014;36:1058–68.
    1. Kim JS, Ko JS, Bang S, Kim H, Lee SY. Cervical plexus block. Korean J Anesthesiol. 2018;71:274–88.
    1. Telford RJ, Stoneham MD. Correct nomenclature of superficial cervical plexus blocks. Br J Anaesth. 2004;92:775.
    1. Pandit JJ, Dutta D, Morris JF. Spread of injectate with superficial cervical plexus block in humans: An anatomical study. Br J Anaesth. 2003;91:733–5.
    1. Nash L, Nicholson HD, Zhang M. Does the investing layer of the deep cervical fascia exist? Anesthesiology. 2005;103:962–8.
    1. Pandit JJ, Krishna RS, Gration P. Superficial or deep cervical plexus block for carotid endarterectomy: A systematic review of complications. Br J Anaesth. 2007;99:159–69.
    1. Ramachandran SK, Picton P, Shanks A, Dorje P, Pandit JJ. Comparison of intermediate vs subcutaneous cervical plexus block for carotid endarterectomy. Br J Anaesth. 2011;107:157–63.
    1. Zhang MN, HD, Nash L. Investing layer of the cervical fascia of the neck may not exit. Anesthesiology. 2006;104:1344–5.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다