A prospective, randomized comparison between combined (deep and superficial) and superficial cervical plexus block with levobupivacaine for minimally invasive parathyroidectomy.
BACKGROUND
Minimally invasive parathyroidectomy (MIP) can be performed under cervical plexus block (CPB). Superficial CPB has been reported to be easier to perform with similar efficacy and less anesthesia-related complications than combined deep and superficial CPB. In this study, we compared the efficacy of superficial and combined (deep and superficial) CPB in patients undergoing MIP.


METHODS
Forty-two patients with primary hyperparathyroidism due to a solitary adenoma were randomized to receive either a superficial (group superficial, n = 20) or a combined deep and superficial CPB (group combined, n = 22) using 0.35 mL/kg of 0.5% levobupivacaine. The primary end-point was the amount of supplemental fentanyl required to complete surgery.


RESULTS
There were no differences in onset of block, pain scores during surgery, or time to first analgesic request between groups. Fentanyl consumption was similar in both groups, i.e., 50 (0-200) microg in group superficial and 50 (0-100) microg in group combined (P = 0.60). Six patients [1 in group superficial (5%) and 5 in group combined (22.7%)] were converted to general anesthesia for surgically required bilateral neck dissection (P = 0.18). General anesthesia for block failure was reported in three superficial (15%) and two combined group patients (9%) (P = 0.99). In group combined, only one patient (4.5%) showed diaphragmatic paresis after the block (P = 0.99).


CONCLUSIONS
Superficial CPB is an alternative to combined block for MIP.
Pintaric
Tatjana Stopar
TS
Department of Anesthesiology, Institute of Oncology, Ljubljana, Slovenia. tstopar@onko-i.si
Hocevar
Marko
M
Jereb
Simona
S
Casati
Andrea
A
Novak Jankovic
Vesna
V
D000236:Adenoma / Q000601:surgery; D000368:Aged; D000779:Anesthetics, Local; D002045:Bupivacaine / Q000031:analogs & derivatives; D002572:Cervical Plexus; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D000077554:Levobupivacaine; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010282:Parathyroid Neoplasms / Q000601:surgery; D016105:Parathyroidectomy; D017060:Patient Satisfaction
D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine