Post Operative Pain Relief After Thyroidectomy
Conditions
Brief summary
Thyroidectomy is commonly associated with mild-to-moderate postoperative pain that may affect respiratory function and recovery. Bilateral intermediate cervical plexus block provides effective analgesia, but larger local anesthetic volumes may increase phrenic nerve spread and diaphragmatic dysfunction. Low-volume ultrasound-guided block may provide adequate analgesia while better preserving diaphragmatic function and postoperative respiratory performance
Detailed description
Thyroidectomy requires effective perioperative analgesia to facilitate swallowing, coughing, deep breathing, and early mobilization. Bilateral intermediate cervical plexus block improves postoperative pain control and reduces opioid requirements, while ultrasound guidance enhances safety and accuracy. However, larger local anesthetic volumes may increase phrenic nerve involvement and diaphragmatic impairment. Ultrasound assessment of diaphragmatic excursion and thickening fraction provides objective evaluation of respiratory function. Low-volume block may preserve diaphragmatic function while maintaining satisfactory analgesic efficacy
Interventions
DRUGBupivacain only
Bilateral intermediate cervical plexus block using ultrasound-guided bupivacaine 0.5% for low volume group
Sponsors
Assiut University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Intervention model description
Ultrasound-guided bilateral intermediate cervical plexus block with bupivacaine
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Adult patients aged between 18 and 65 years. * Patients scheduled for elective thyroidectomy under general anesthesia. * American Society of Anesthesiologists (ASA) physical status I-II. * Both sexes will be included. * Patients able to understand the study protocol and provide written informed consent.
Exclusion criteria
* Patient refusal. * Other endocrine diseases (as uncontrolled diabetes mellitus, adrenal disorders, pituitary disorders) * Known allergy or hypersensitivity to local anesthetics. * Coagulopathy or ongoing anticoagulant therapy contraindicating regional anesthesia. * Local infection at the site of needle insertion. * Preexisting diaphragmatic dysfunction or phrenic nerve palsy. * Significant chronic respiratory disease affecting pulmonary function (e.g., severe COPD, restrictive lung disease, uncontrolled asthma). * Morbid obesity (BMI ≥ 35 kg/m²). * Psychiatric or neurological diseases affecting respiratory muscles. * Previous neck surgery or anatomical deformity interfering with cervical plexus --block performance or diaphragmatic ultrasound assessment. * Pregnancy..
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in diaphragmatic excursion in patient undergoing thyroidectomy | Baseline before block, 30 minutes after block.4 hour after block | Ultrasound-measured diaphragmatic excursion (cm), assessed at baseline before block and at predefined postoperative time points, to compare the effect of low-volume versus standard-volume bilateral intermediate cervical plexus block on diaphragmatic function. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Score visual analog scale (vas) | Postoperative pain score PACU arrival (0 hour), 6 hour, 12 hour, and 24 hour postoperatively | Postoperative pain assessed using the Visual Analog Scale (VAS, 0-10) at rest and during swallowing. |
| Total opioid consumption in 24hr postoperative | After 24hour PACu arrival | Total amount of opioid consumption in patient undergoing thyroidectomy for first 24hr postoperative |
Countries
Egypt
Contacts
CONTACTAhmed A Abdelsalam, Master
CONTACTNashua F Abdelhafaz, MD
PRINCIPAL_INVESTIGATORMostafa S Samy, MD
Assiut university faculty of medicine
Outcome results
None listed