title: Local/cervical block anesthesia versus general anesthesia for minimally invasive parathyroidectomy: what are the advantages?
abstract: BACKGROUND
  Minimally invasive parathyroidectomy (MIP) under local/cervical block anesthesia (LA) is safe and effective for patients with primary hyperparathyroidism (HPT). Advantages of LA versus general anesthesia (GA) for these focused procedures have not been clearly demonstrated.
  
  
  METHODS
  Between 3/01 and 6/04, 177 consecutive patients with primary HPT and positive localization studies underwent MIP. Seventy-three (41%) had surgery under LA while 104 (59%) had GA. Primary endpoints were IV narcotic use, anti-emetic use, nausea, vomiting, and post-operative pain.
  
  
  RESULTS
  Patients who had parathyroidectomy under LA were older (64 +/- 2 vs. 57 +/- 2 years, P = 0.001). Cure and complication rates were identical between the two groups. Patients who had parathyroidectomy under LA required less IV narcotic pain mediation (mean morphine equivalents 11.4 +/- 1.3 mg vs. 22.5 +/- 1.1 mg; P < 0.001) compared to GA patients. The LA patients had better pain control as shown by lower post-operative peak pain scores (2.9 +/- 0.3 vs. 5.0 +/- 0.4; P < 0.001) and lower overall pain scores (mean 1.9 +/- 0.2 vs. 3.1 +/- 0.2; P < 0.001). The LA group required fewer anti-emetic medications compared to the GA patients (mean 0.4 +/- 0.1 vs. 1.7 +/- 0.1 doses; P < 0.001). Fewer LA patients experienced post-operative nausea (16% vs. 49%; P < 0.001), and vomiting (7% vs. 24%; P = 0.002). Length of stay was similar between the groups (0.4 +/- 0 vs. 0.3 +/- 0; P = 0.22).
  
  
  CONCLUSIONS
  In this study the choice of anesthesia did not affect surgical cure rate, morbidity, or length of stay. LA was associated with significantly lower post-operative pain, nausea, and vomiting. LA appears to offer specific advantages more than GA for patients undergoing MIP.
authors.affiliation: Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Black
authors.forename: Ann E
authors.initials: AE
authors.lastname: Ruscher
authors.forename: Julie
authors.initials: J
authors.lastname: Lederman
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
mesh_terms: D000768:Anesthesia, General; D000772:Anesthesia, Local; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009407:Nerve Block; D016105:Parathyroidectomy / Q000379:methods*; D011877:Radionuclide Imaging