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Analgesic Effects of Ultrasound-Guided Serratus-Intercostal Plane Block and Ultrasound-Guided Intermediate Cervical Plexus Block After Single-Incision Transaxillary Robotic Thyroidectomy: A Prospective, Randomized, Controlled Trial
  1. Jin-Soo Kim, MD, PhD*,
  2. Jeonghun Lee, MD,
  3. Euy-Young Soh, MD, PhD,
  4. Hyoeun Ahn, MD*,
  5. Sang Eon Oh, MD*,
  6. Jung-Dong Lee, MS and
  7. Han Bum Joe, MD, PhD*
  1. From the *Department of Anesthesiology and Pain Medicine, †Department of Surgery, and ‡Office of Biostatistics, Ajou University School of Medicine, Suwon, Republic of Korea
  1. Address correspondence to: Han Bum Joe, MD, PhD, Department of Anesthesiology and Pain Medicine, Ajou University Hospital, 164, World Cup-ro, Yeongtong-gu, Suwon 443-380, Republic of Korea (e-mail:


Background and Objectives Single-incision transaxillary robotic thyroidectomy (START) requires substantial tissue disruption, which produces moderate-to-severe pain in the axilla and neck areas during the early postoperative period. This study aimed to investigate the analgesic effects of ultrasound-guided serratus-intercostal plane blocks and intermediate cervical plexus blocks (CPBs) on the early postoperative pain after START.

Methods We randomized 22 patients to undergo either ultrasound-guided serratus-intercostal plane and intermediate CPBs (the block group, n = 11) or to not undergo any block (the control group, n = 11). We compared postoperative axillary pain, postoperative neck pain, and analgesic use between the groups during the first 24 hours. The rescue analgesics were intravenous fentanyl (0.5 μg/kg) in the postanesthesia care unit, and intravenous ketorolac tromethamine (30 mg) in the general ward.

Results The block group showed consistently lower pain scores than the control group in the axillary area in the first 24 hours and in the neck area only in the first 3 hours after surgery. The numbers (proportions) of patients who required analgesics were 11 (100%) in the control group and 6 (54.5%) in the block group during the first 24 hours (P = 0.035). No adverse effect was observed related to the peripheral nerve blocks.

Conclusions After START, a serratus-intercostal plane block performed at the level of the third rib was an effective analgesic technique for axillary pain; however, the clinical effectiveness of intermediate CPB for neck pain may be limited.

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  • The authors declare no conflict of interest.

    This study was presented as an abstract at the European Society of Regional Anaesthesia and Pain Therapy 34th Annual Congress 2015, Ljubljana, Slovenia.