title: The benefits of preincision ropivacaine infiltration for reducing postoperative pain after robotic bilateral axillo-breast approach thyroidectomy: a prospective, randomized, double-blind, placebo-controlled study.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effects of preoperative ropivacaine infiltration in patients undergoing robotic thyroidectomy using the bilateral axillary breast approach method.
  
  
  METHODS
  Using a randomized, double-blind study design, 34 consecutive female patients who underwent robotic thyroidectomy were randomly assigned to receive local infiltration to the skin flap site using either only 0.9% saline solution, 3 mL/kg (group C, n = 17) or 0.1% ropivacaine with saline, 3 mg/kg (group L, n = 17). Local anesthetic was administered prior to skin incision after the induction of general anesthesia. Postoperative pain was rated at 2, 6, 18, 30, 42, and 66 hours postoperatively by visual analogue scale (VAS) score. The bottom hit counts (BHC) from patient controlled analgesia and fentanyl consumption were evaluated. CRP levels, mean blood pressure (BP), and heart rate (HR) were also evaluated.
  
  
  RESULTS
  VAS pain scores were significantly lower in group L than in group C from 2 to 42 hours (P < 0.05). Fentanyl use for analgesia and BHC were also significantly lower in group L compared with group C during the first postoperative 6 and 2 hours, respectively (P < 0.05). The total consumption of fentanyl was significantly lower in group L than in group C (P = 0.009). No significant differences were noted for baseline, postoperative mean BP, or HR.
  
  
  CONCLUSIONS
  Preoperative infiltration using ropivacaine with saline to all flap sites is a safe and effective method for reducing postoperative pain and postoperative fentanyl consumption in patients with robotic thyroidectomy.
authors.affiliation: Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Kyung Ho
authors.initials: KH
authors.lastname: Kang
authors.affiliation: Department of Surgery, Onuri Hospital, Incheon, Korea.
authors.forename: Byung Seup
authors.initials: BS
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Kang
keywords: Pain; Robotics; Thyroidectomy
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