The bilateral superficial cervical plexus block with 0.75% ropivacaine administered before or after surgery does not prevent postoperative pain after total thyroidectomy.
OBJECTIVE
Patients undergoing thyroid surgery need postoperative pain management. Bilateral superficial cervical plexus block by administration of 0.25% bupivacaine with 1:200000 epinephrine at the end of surgery has been shown to improve postoperative analgesia. The objective of this study was to assess the analgesic efficacy in the first 36 postoperative hours after total thyroidectomy of bilateral superficial cervical plexus block with 0.75% ropivacaine administered before the incision or on completion of the surgical procedure.


METHODS
We performed a prospective double-blinded, randomized controlled trial that compared 3 parallel groups: the CONT group did not receive any block, the PRE group received bilateral superficial cervical plexus block before surgery while under general anesthesia, and the POST group received bilateral superficial cervical plexus block after surgery while under general anesthesia. The study included 111 patients (37 in each group). Postoperative pain was assessed every 4 hours by use of a 0 to 10 numeric rating scale. All patients received paracetamol every 6 hours. Morphine was administered following a standardized protocol if the numeric rating scale was 4 or higher. The main outcome variables were the proportion of patients given morphine during the 36 hours period, pain intensity scores, and morphine consumption.


RESULTS
No intergroup differences were observed in terms of percentage of patients who required morphine, morphine delivery, pain scores, and intraoperative opioid consumption.


CONCLUSIONS
Bilateral superficial cervical plexus block with 0.75% ropivacaine administered before or after surgery does not improve postoperative analgesia after total thyroidectomy.
Herbland
Alexandre
A
Department of Anesthesiology and Intensive Care 2, Centre Hospitalier Universitaire (CHU) de Bordeaux. Université Bordeaux, 2 Victor Segalen, Bordeaux, France. alexandre.herbland@wanadoo.fr
Cantini
Olivier
O
Reynier
Patrick
P
Valat
Philippe
P
Jougon
Jacques
J
Arimone
Yannick
Y
Janvier
Gerard
G
D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000577:Amides / Q000627:therapeutic use*; D000700:Analgesics / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002572:Cervical Plexus; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D000077212:Ropivacaine; D013965:Thyroidectomy; D016896:Treatment Outcome
D000577:Amides; D000700:Analgesics; D000779:Anesthetics, Local; D000082:Acetaminophen; D009020:Morphine; D000077212:Ropivacaine