title: Pain and surgical outcomes with and without neck extension in standard open thyroidectomy: a prospective randomized trial.
abstract: BACKGROUND
  The purpose of this study was to compare surgical outcomes between those patients who underwent open thyroidectomy with and without neck extension.
  
  
  METHODS
  One hundred eighty patients were randomized into 2 groups, with neck extension (group I) and without neck extension (group II). Outcomes included pain score on postoperative day 0, day 1, and the first clinic visit, operating time, blood loss, recurrent laryngeal nerve (RLN) injury, and hypoparathyroidism.
  
  
  RESULTS
  Pain scores in group II were significantly lower on postoperative day 1 (2.38 vs 3.08; p = .022) and at the first clinic visit (0.57 vs 0.78; p = .026). There was a significant direct correlation between degree of neck extension and pain score on day 1 (p = .159 and p = .033). Other outcomes seemed comparable. However, the overall RLN injury rate was not significantly different between the 2 groups (5.3% vs 2.0%; p = .212).
  
  
  CONCLUSIONS
  Compared to group I, pain on postoperative day 1 and at the first visit in group II were significantly less, but both groups had similar overall RLN injury rate.
authors.affiliation: Department of Surgery, University of Hong Kong, Pokfulam, Hong Kong SAR, China.
authors.forename: Brian Hung-Hin
authors.initials: BH
authors.lastname: Lang
authors.forename: Sze-How
authors.initials: SH
authors.lastname: Ng
authors.forename: Kai Pun
authors.initials: KP
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000473:pathology* / Q000601:surgery*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000254:growth & development*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
keywords: analgesia; hypoparathyroidism; neck extension; postoperative hypocalcemia; postoperative pain; randomized trial; recurrent laryngeal nerve; thyroidectomy