title: Randomized controlled trial on the efficacy of bilateral superficial cervical plexus block in thyroidectomy.
abstract: OBJECTIVE
  As thyroid surgery is being performed as an ambulatory procedure, recent studies concerning post thyroidectomy analgesia have focused on regional techniques such as bilateral superficial cervical plexus block (BSCPB) and bilateral combined superficial and deep cervical plexus block. But, data regarding the efficacy of BSCPB are controversial. Hence we compared the efficacy of BSCPB with 0.25% bupivacaine with and without clonidine in thyroidectomy, as preventative analgesia.
  
  
  METHODS
  Patients (n = 60) undergoing thyroidectomy were randomized into 3 groups (n = 20 each) to receive BSCPB using 15 mL of 0.25% bupivacaine (group B) or 0.25% bupivacaine with 1 μg/kg clonidine (group BC) or 0.9% normal saline (group S) on each side after induction. Intraoperative (fentanyl) and postoperative (morphine) analgesic requirements were assessed. Postoperative pain scores, nausea, vomiting, and sedation were assessed for 24 hours.
  
  
  RESULTS
  Intraoperative fentanyl requirement was significantly lesser in groups B and BC (P = 0.012). Postoperative pain scores were significantly lower in group BC (compared to S) at 2 (P = 0.002), 4 (P = 0.016), and 8 (P = 0.012) hours. First analgesic requirement time (min) was significantly higher in groups B and BC (P = 0.002), and postoperative morphine requirement was significantly lower in groups B and BC (P = 0.001). Incidence of postoperative vomiting was significantly reduced in group BC (P = 0.022).
  
  
  CONCLUSIONS
  BSCPB with 0.25% bupivacaine with or without clonidine is effective in reducing both intraoperative and postoperative pain and analgesic requirements in thyroidectomy, and adding clonidine to bupivacaine reduces postoperative vomiting.
authors.affiliation: Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
authors.forename: Vilvapathy Senguttuvan
authors.initials: VS
authors.lastname: Karthikeyan
authors.forename: Sarath Chandra
authors.initials: SC
authors.lastname: Sistla
authors.forename: Ashok Shankar
authors.initials: AS
authors.lastname: Badhe
authors.forename: Thulasingam
authors.initials: T
authors.lastname: Mahalakshmy
authors.forename: Nagarajan
authors.initials: N
authors.lastname: Rajkumar
authors.forename: Sheik Manwar
authors.initials: SM
authors.lastname: Ali
authors.forename: S
authors.initials: S
authors.lastname: Gopalakrishnan
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D002572:Cervical Plexus / Q000187:drug effects; D003000:Clonidine / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D013965:Thyroidectomy / Q000379:methods*
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D003000:Clonidine; D002045:Bupivacaine
keywords: anesthesia; anesthesia and analgesia; local; patient-controlled analgesia; randomized controlled trial; superficial cervical plexus block; thyroidectomy