Lack of Analgesic Effect Induced by Ropivacaine Wound Infiltration in Thyroid Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial.
BACKGROUND
Surgical site infiltration with local anesthetic reduces analgesic requests in various types of surgeries. Because thyroid surgery may induce severe postoperative pain, we tested the hypothesis that ropivacaine surgical site infiltration would significantly decrease postoperative administration of morphine in patients undergoing thyroid surgery.


METHODS
We performed a double-blind, placebo-controlled superiority trial to assess the efficacy of surgical site analgesia with ropivacaine (10 mL, 75 mg) performed at the end of thyroid surgery in adult patients. The primary end point was the proportion of patients not requiring IV morphine in the postanesthesia care unit.


RESULTS
One hundred sixty-three patients completed the study, 85 in the placebo group and 88 in the ropivacaine group. The proportion of patients requiring morphine administration in the postanesthesia care unit (55% vs 53%, P = 0.80), the dose of IV morphine administered (5.6 ± 6.1 vs 5.5 ± 6.0 mg, P = 0.90), the total dose of opioids administered (expressed as oral morphine equivalent dose: 64 ± 27 vs 69 ± 29 mg, P = 0.20), and the visual analog pain scale over the first 24 hours were not significantly different between groups. The incidence of adverse events (36% vs 39%, P = 0.88), morphine-related adverse events (19% vs 17%, P = 0.84), serious adverse events (0% vs 2%, P = 0.50), and the patient satisfaction scores (9 ± 1 vs 9 ± 1, P = 0.70) was not significantly different between the 2 groups.


CONCLUSIONS
Surgical site analgesia with ropivacaine at the end of thyroid surgery is not associated with any significant analgesic benefit.
From the Departments of *Anesthesia and Critical Care, †General Surgery, and ‡Emergency Medicine, Pitié-Salpetrière Hospital, Pierre et Marie Curie University, Paris, France; and §Department of Anesthesia and Critical Care, Croix-Rousse Hospital, Claude Bernard Lyon 1 University, Lyon, France.
Mihaela
M
Miu
Catherine
C
Royer
Carmen
C
Gaillat
Barbara
B
Schaup
Fabrice
F
Menegaux
Olivier
O
Langeron
Bruno
B
Riou
Frédéric
F
Aubrun
D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D011446:Prospective Studies; D000077212:Ropivacaine; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy
D000577:Amides; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine