Cervical, Erector Spinae Plane Block, Cervical Plexus Block, Postoperative Pain, Thyroidectomy
Conditions
Brief summary
This study aims to compare the efficacy and safety of cervical erector spinae plane block vs. cervical plexus block in controlling acute postoperative pain after thyroidectomy.
Detailed description
Thyroidectomy is one of the most commonly performed surgeries in females worldwide, as thyroid disease predominantly affects females with a ratio of 4:1. Thyroid operations can cause mild to moderate incisional pain. It has also been reported that the morphine consumption on the first postoperative day is 90%. Cervical plexus block, either superficial or deep or combinations given bilaterally, could easily lead to an adequate block appropriate for thyroid surgery without any significant side effects. Erector spinae plane block (ESPB) is the new favorite among various fascial plane blocks. Local anesthetic drug is injected in the fascial plane superficial to the transverse process and deeper to the erector spinae muscle (ESM).
Interventions
Patients will receive bilateral ultrasound-guided cervical erector spinae plane block using 15 ml of bupivacaine 0.25% on each side.
Patients will receive bilateral ultrasound-guided superficial cervical block using 15 mL of 0.25% plain bupivacaine on each side of the neck.
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age from 18 to 65 years. * Both genders. * American Society of Anesthesiologists (ASA) physical status I-II. * Scheduled for either hemi- or total thyroidectomy.
Exclusion criteria
* Known allergy to local anesthetics. * Allergy to all opioid medications. * Pregnant patient. * Previous neck surgery. * Recent use of non-steroidal anti-inflammatory drugs (NSAIDs), opioids or steroid injection within 2 weeks. * Those who cannot utilize the numeric rating scale (NRS) . * Chronic opioid use. * Coagulopathy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total morphine consumption | 48 hours postoperatively | Rescue analgesia of morphine will be given as 3 mg bolus if the numeric rating scale (NRS) \> 3 to be repeated after 30 min if pain persists until the NRS \< 4. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to the 1st rescue analgesia | 48 hours postoperatively | Time to the first request for the rescue analgesia (time from end of surgery to first dose of morphine administrated). |
| Intraoperative fentanyl consumption | Intraoperatively | Additional bolus doses of fentanyl 1 µg/kg will be given if the mean arterial blood pressure (MAP) or heart rate (HR) rises above 20% of baseline levels. |
| Degree of pain | 48 hours postoperatively | Each patient will be instructed about postoperative pain assessment with the numeric rating scale (NRS) score. NRS (0 represents no pain while 10 represents the worst pain imaginable). NRS will be assessed at post-anesthesia care unit (PACU), 1, 2, 4, 6, 8, 12, 18, 24, 36 and 48 h postoperative. |
| Incidence of adverse events | 48 hours postoperatively | Incidence of adverse events such as nausea, vomiting, hypotension, bradycardia, cough, bronchospasm, and sore throat will be recorded. |
Countries
Egypt
Outcome results
None listed