RT Journal Article
SR Electronic
T1 EP044 Comparison of ultrasound guided bilateral intermediate cervical plexus block and superficial cervical plexus block in patients undergoing thyroid surgery under general anaesthesia
JF Regional Anesthesia & Pain Medicine
JO Reg Anesth Pain Med
FD BMJ Publishing Group Ltd
SP A62
OP A63
DO 10.1136/rapm-2023-ESRA.106
VO 48
IS Suppl 1
A1 Sharma, Abhinav
A1 Chhabra, Anjolie
A1 Bhoi, Debesh
A1 Ray, Bikash Ranjan
A1 Kumar, Rakesh
A1 Srivastava, Anurag
A1 Madan, Karan
A1 Mani, Kalaivani
YR 2023
UL http://rapm.bmj.com/content/48/Suppl_1/A62.3.abstract
AB Background and Aims Thyroid surgery maybe associated with mild-moderate pain, with 66-90% patients requiring opioids on the first postoperatively. This study compared superficial cervical plexus block (SCPB) [USG subcutaneous local anaesthetic (LA) injection at Erb’s point] and intermediate CPB (IMCPB) [USG LA injection below posterior SCM border] for thyroid surgery under general anaesthesia. Primary outcome was 24-hr postoperative fentanyl requirement; secondary outcomes included time to first analgesic, 24-hr pain at rest and swallowing, pre and 20 min post block diaphragmatic excursions (normal, deep breathing, sniffing), diaphragmatic thickening fraction (TFdi), PFT (phrenic nerve function), hoarseness (RLN nerve function), Horner’s syndrome and dermatomes blocked.Methods Following ethics committee approval, 57 consenting ASA I-II, 18-75-year patients undergoing thyroidectomy were randomly allocated to IMCPB (n=28) or SCPB (n=29) groups. Ropivacaine 10ml, 0.375% was injected bilaterally, pre-induction in both groups.View this table:Abstract EP044 Table 1 Perioperative fentanyl requirementView this table:Abstract EP044 Table 2 Diaphragmatic excursion and other adverse effectsAbstract EP044 Figure 1 Incisional pain VAS (0-100mm) at rest and swallowing at 0,1,2,4,6 and 24 hours postoperativelyResults C2-C4 dermatomes were blocked in both groups. 24-hr postoperative fentanyl requirement was significantly lower and time to first rescue analgesic was shorter in the IMCPB group. (table 1) VAS on rest and swallowing was significantly lower in the IMCPB group for 2-hrs and at 24-hrs. (figure 1) 53% IMCPB patients developed a sympathetic haemodynamic response 5min post-block that lasted for 30-45min. Diaphragmatic excursions on deep breathing and PEFR were significantly reduced in the IMCPB group. Incidence of hoarseness, ear lobe numbness, Horner’s syndrome was significantly higher in the IMCPB group. (table 2)Conclusions IMCPB resulted in better analgesia but more adverse effects. Further studies need to ascertain optimal LA dose for IMCPB in patients undergoing thyroid surgery.