title: A prospective, randomized, controlled trial of the postoperative analgesic effects of spraying 0.25 % levobupivacaine after bilateral axillo-breast approach robotic thyroidectomy.
abstract: BACKGROUND
  Robotic thyroidectomy (RoT) is frequently performed due to its excellent cosmesis and recovery features. However, postoperative pain in the operating field after RoT remains a concern due to extensive tissue dissection and tension during the operation. The aim of this study was to evaluate the anterior chest pain and the effect of levobupivacaine spraying on postoperative pain control after bilateral axillo-breast approach (BABA) RoT.
  
  
  METHODS
  We randomized 55 adult patients scheduled for BABA RoT into the control group (group C, n = 27) or the levobupivacaine group (group L, n = 28). At the end of surgery, patients in groups C and L were sprayed with the same volume (30 ml) of normal saline and 0.25 % levobupivacaine, respectively, on the flap dissection area. Pain scores, the consumption of patient-controlled analgesia (PCA), and other adverse effects were assessed at 1, 6, 24, and 48 h postoperatively.
  
  
  RESULTS
  Patients in group L showed lower pain scores than those of group C at 1 h (50 [0-100] vs. 80 [20-100]; p = 0.004), 6 h (30 [0-90] vs. 70 [30-90]; p < 0.001), 24 h (30 [0-80] vs. 50 [10-80]; p = 0.016) and 48 h (10 [0-80] vs. 30 [10-80]; p < 0.001) postoperatively. PCA consumption of group L was less than that of group C at 6, 24, and 48 h after surgery. There were no significant differences in postoperative nausea-vomiting, headache, or dizziness. Local anesthetic-related adverse effects were not reported.
  
  
  CONCLUSIONS
  Levobupivacaine spray on the operative field at the end of BABA RoT reduced postoperative pain and PCA consumption without adverse events.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea.
authors.forename: Jung-Hee
authors.initials: JH
authors.lastname: Ryu
authors.forename: Cha Kyong
authors.initials: CK
authors.lastname: Yom
authors.forename: Hyungju
authors.initials: H
authors.lastname: Kwon
authors.forename: Kyu Hyung
authors.initials: KH
authors.lastname: Kim
authors.forename: June Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Jun Woo
authors.initials: JW
authors.lastname: Jung
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Ah-Young
authors.initials: AY
authors.lastname: Oh
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use*; D001365:Axilla; D001940:Breast; D002045:Bupivacaine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D011446:Prospective Studies; D065287:Robotic Surgical Procedures; D013965:Thyroidectomy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine