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Background and Aims Focused Parathyroidectomy is usually performed under general anaesthesia. Cervical plexus block as a sole anaesthesia for parathyroidectomy has been rarely used. In this case series, we describe application of combined superficial and intermediate cervical plexus (ICPB)block in two high risk patients scheduled for focused parathyroidectomy.

Methods First case fifty year old male with hyperparathyroidism, motor neuron disease and inflammatory polyarthritis, on examination he had dysarthria, tongue fasciculations, absent gag reflex and poor effort tolerance. Second case was a forty year old female with hyperparathyroidism, hypertension, recurrent renal stones and recent history of recovery from typhoid fever. Due to high risk of prolong post operative mechanical ventilation in first case and in view of recent history of typhoid fever in second case regional anaesthesia was planned in these two cases. At the midpoint of sternocleidomastoid(SCM)),ultrasound guided ICPB was given with 8 mL of 0.5% ropivacaine (figure 1).Through same entry point needle 8 mL of 0.5% ropivacaine was deposited to give a single point subcutaneous superficial cervical plexus block (figure 2). Block was repeated on the other side as well.

Results In both the two cases, cervical plexus block provided excellent surgical condition with good postoperative pain relief.

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Abstract EP183 Figure 1

Superficial Cervical Plexus Block-(LA) Local Anaesthetic Spread, (SCM) Sternocleidomastoid, (IJV) Internal Jugular Vein, (ICA)Internal Carotid Artery

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Abstract EP183 Figure 2

Intermediate Cervical Plexus Block-(LA) Local Anaesthetic Spread, (SCM) Sternocleidomastoid, (IJV) Internal Jugular Vein, (ICA) Internal Carotid Artery

Conclusions Superficial and intermediate cervical plexus block can be considered as a sole anaesthesia technique for focused parathyroidectomy as it provide prolonged postoperative analgesia, reduce the requirements for opioid analgesics and early discharge after surgery.