Thyroid Surgery
Conditions
Brief summary
Thyroid gland surgery is one of the most commonly performed operations for either benign or malignant pathologies Pain related to thyroid surgery is of moderate intensity .which may be treated with NSAIDs or opioids. However, Opioids have many well-known undesirable effects, including postoperative nausea and vomiting, which are frequent after this type of procedure.
Detailed description
Regional techniques of anesthesia may help to decrease post-operative pain and reduce systemic analgesic requirement. Classically, the cervical plexus is considered to have two distributions, the superficial cutaneous and the deep motor nerves. Anatomically, the thyroid gland has an inner true capsule which is thin and adheres closely to the thyroidal tissue \[Fancy et al., 2010\]. External to this is a false capsule formed by the middle layer of the deep cervical fascia, which splits anterolaterally to ensheathe the thyroid gland, thus forming the thyroid sheath \[Bliss et al., 2000\]. In this fashion, the potential space called the capsule-sheath space is formed. It contains also loose connective tissue, blood vessels, nerves and parathyroid gland. Anesthetic deposited in this space would block the surface of thyroid gland and permeate directly into the parenchyma producing effective local anesthesia for thyroid surgical procedures. It is supposed also to involve autonomic nerve block of the thyroid gland \[Fliers et al., 2010\]. Additionally, a subcutaneous injection along the sternocleidomastoid muscle (SCM) would also enhance effective local anesthesia for the initial skin incision and further contribute to a more ideal working environment for the surgeon. Therefore, anesthetic technique termed ultrasound-guided capsule-sheath space block (CSSB) combined with anterior cervical cutaneous nerves block (CCNB) for thyroidectomy is done \[Wang et al., 2015\] . Our hypothesis is that a combination of simple dual techniques including superficial cutaneous block to provide sensory blockade, and surgeon mediated capsular block may afford autonomic thyroid blockade. In comparison, ultrasound guided intermediate cervical plexus block may provide these blocks but using a machine and deep penetration possibly involving unwanted blocks for phrenic and recurrent laryngeal nerves. So, if the simple safe technique can provide the same intra and postoperative anesthetic conditions it will be preferred.
Interventions
PROCEDURECapsule and cutaneous blocks
7.5 mL of 0.5% bupivacaine + Epinephrine 5 ug/ ml for both blocks once before surgery per side
PROCEDUREUS-intermediate cervical plexus block
15 mL of 0.5% bupivacaine + Epinephrine 5 ug/ ml once before surgery per side.
Sponsors
Mansoura University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists physical status grade I and grade II. * Euthyroidism after thyroid function tests
Exclusion criteria
* Patient refusal. * Thyroid gland more than 5 cm size. * Retrosternal extension. * Planned block neck dissection. * Neuromuscular diseases * Hematological diseases. * Bleeding diseases. * Coagulation abnormality. * Psychiatric diseases. * Drug abuse. * Local skin infection * sepsis at site of the block. * Known intolerance to the study drugs. * Body Mass Index \> 40 Kg/m2. * Known diaphragmatic motion abnormalities * major respiratory disease. * Previous history of cervical surgery.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total dose of opioid analgesics used | For 24 hours after surgery | The total dose of opioid analgesics required in the post-operative periods |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to first analgesic request | For 24 hours after surgery | Time to first request for a rescue analgesic |
| Fentanyl use | For 5 hours after start of anaesthesia | Intraoperative use of fentanyl |
| Rocuronium use | For 5 hours after start of anaesthesia | Intraoperative use of rocuronium |
| Sensory blockade | for 1 hour after surgery | Assessment of sensory blockade |
| Diaphragmatic dysfunction | for 5 hours after performing blockade | Diaphragmatic dysfunction using ultrasound assessment and possible x ray |
| Sedation score | for 5 hours after performing blockade | Sedation score using Modified Ramsay scale |
| Postoperative pain | For 24 hours after surgery | Postoperative visual analogue score (VAS) (0 no pain -10 worst imaginable pain), |
| Postoperative nausea and vomiting | For 24 hours after surgery | frequency |
| Postoperative headache | For 24 hours after surgery | frequency |
| Hoarseness of voice | For 24 hours after surgery | frequency |
| Dysphagia | For 24 hours after surgery | frequency |
| Respiratory difficulty | For 24 hours after surgery | Peripheral oxygen saturation less than 92% |
| Patient satisfaction | for 24 hrs after surgery | Patient satisfaction regards analgesia using a score of (0-10) with 10 represents the highest satisfaction |
Countries
Egypt
Outcome results
None listed