title: Thyroidectomy: exactly how painful is it?
abstract: BACKGROUND
  The level of pain post-conventional thyroidectomy has been studied from two aspects: the short-term effect of different perioperative analgesics on the pain level and in comparison with endoscopic thyroidectomy.
  
  
  OBJECTIVE
  The level of pain experienced post-open thyroidectomy and postoperative long-term analgesia requirements have not been prospectively studied. We have undertaken this study to have a clearer understanding of this issue. We also compared the implication of two different surgical approaches toward the sternothyroid muscle: retraction versus incision on the level of postoperative pain.
  
  
  METHODS
  Prospective screening of 53 patients undergoing total thyroidectomy was conducted. Patients received a form containing information as to analgesic drugs taken postoperatively and a self-estimated pain severity scale.
  
  
  RESULTS
  The pain level decreased steadily from the first postoperative evening, and the average pain level at the peak was moderate. Most of the patients chose not to use narcotics. In our study population, males, as a trend, reported higher pain levels compared with females and for a longer duration. Sternothyroid muscle division did not increase pain level, the duration of pain, or the pattern of postoperative analgesic requirements.
  
  
  CONCLUSIONS
  We recommend that only patients with severe pain, on the first postoperative day, be prescribed mild narcotics in small quantities. All others can be prescribed with a nonnarcotic analgesia. We did not find evidence that sternothyroid muscle splitting causes more pain; hence it should be used at the surgeon's discretion.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital Faculty of Medicine, McGill University, Montreal, Quebec. limorm@013.net.il
authors.forename: Limor Muallem
authors.initials: LM
authors.lastname: Kalmovich
authors.forename: Valerie
authors.initials: V
authors.lastname: Cote
authors.forename: Noah
authors.initials: N
authors.lastname: Sands
authors.forename: Martin
authors.initials: M
authors.lastname: Black
authors.forename: Richard
authors.initials: R
authors.lastname: Payne
authors.forename: Michael
authors.initials: M
authors.lastname: Hier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D011446:Prospective Studies; D012720:Severity of Illness Index; D013961:Thyroid Gland / Q000601:surgery*
chemical_list: D000700:Analgesics