title: Bilateral superficial cervical plexus block combined with general anesthesia administered in thyroid operations.
abstract: BACKGROUND
  We investigated the analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy and to determine whether it reduces the adverse effects of general anesthesia.
  
  
  METHODS
  We prospectively recruited 162 patients who underwent elective thyroid operations from March 2006 to October 2007. They were randomly assigned to receive a bilateral superficial cervical block (12 ml per side) with isotonic saline (group A; n = 56), bupivacaine 0.5% (group B; n = 52), or levobupivacaine 0.5% (group C; n = 54) after induction of general anesthesia. The analgesic efficacy of the block was assessed with: intraoperative anesthetics (desflurane), numbers of patients needing postoperative analgesics, the time to the first analgesics required, and pain intensity by visual analog scale (VAS). Postoperative nausea and vomiting (PONV) for 24 h were also assessed by the "PONV grade." We also compared hospital stay, operative time, and discomfort in swallowing.
  
  
  RESULTS
  There were no significant differences in patient characteristics. Each average end-tidal desflurane concentration was 5.8, 3.9, and 3.8% in groups A, B, and C, respectively (p < 0.001). Fewer patients in groups B and C required analgesics (A: B: C = 33:8:7; p < 0.001), and it took longer before the first analgesic dose was needed postoperatively (group A: B: C = 82.1:360.8:410.1 min; p < 0.001). Postoperative pain VAS were lower in groups B and C for the first 24 h postoperatively (p < 0.001). Incidences of overall and severe PONV were lower, however, there were not sufficient numbers of patients to detect differences in PONV among the three groups. Hospital stay was shorter in group B and group C (p = 0.011). There was no significant difference in operative time and postoperative swallowing pain among the three groups.
  
  
  CONCLUSIONS
  Bilateral superficial cervical plexus block reduces general anesthetics required during thyroidectomy. It also significantly lowers the severity of postoperative pain during the first 24 h and shortens the hospital stay.
authors.affiliation: Division of General Surgery, Department of Surgery, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC. judeshih@gmail.com
authors.forename: Ming-Lang
authors.initials: ML
authors.lastname: Shih
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.forename: Chung-Bao
authors.initials: CB
authors.lastname: Hsieh
authors.forename: Yao-Chi
authors.initials: YC
authors.lastname: Liu
authors.forename: Chueng-He
authors.initials: CH
authors.lastname: Lu
authors.forename: Chih-Shung
authors.initials: CS
authors.lastname: Wong
authors.forename: Jyh-Cherng
authors.initials: JC
authors.lastname: Yu
authors.forename: Chun-Chang
authors.initials: CC
authors.lastname: Yeh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D000779:Anesthetics, Local; D002045:Bupivacaine / Q000031:analogs & derivatives; D002572:Cervical Plexus; D005260:Female; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D013959:Thyroid Diseases / Q000601:surgery*; D013961:Thyroid Gland / Q000601:surgery; D013965:Thyroidectomy; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine