title: Analgesic Effects of Ultrasound-Guided Serratus-Intercostal Plane Block and Ultrasound-Guided Intermediate Cervical Plexus Block After Single-Incision Transaxillary Robotic Thyroidectomy: A Prospective, Randomized, Controlled Trial.
abstract: OBJECTIVE
  Single-incision transaxillary robotic thyroidectomy (START) requires substantial tissue disruption, which produces moderate-to-severe pain in the axilla and neck areas during the early postoperative period. This study aimed to investigate the analgesic effects of ultrasound-guided serratus-intercostal plane blocks and intermediate cervical plexus blocks (CPBs) on the early postoperative pain after START.
  
  
  METHODS
  We randomized 22 patients to undergo either ultrasound-guided serratus-intercostal plane and intermediate CPBs (the block group, n = 11) or to not undergo any block (the control group, n = 11). We compared postoperative axillary pain, postoperative neck pain, and analgesic use between the groups during the first 24 hours. The rescue analgesics were intravenous fentanyl (0.5 μg/kg) in the postanesthesia care unit, and intravenous ketorolac tromethamine (30 mg) in the general ward.
  
  
  RESULTS
  The block group showed consistently lower pain scores than the control group in the axillary area in the first 24 hours and in the neck area only in the first 3 hours after surgery. The numbers (proportions) of patients who required analgesics were 11 (100%) in the control group and 6 (54.5%) in the block group during the first 24 hours (P = 0.035). No adverse effect was observed related to the peripheral nerve blocks.
  
  
  CONCLUSIONS
  After START, a serratus-intercostal plane block performed at the level of the third rib was an effective analgesic technique for axillary pain; however, the clinical effectiveness of intermediate CPB for neck pain may be limited.
authors.affiliation: From the *Department of Anesthesiology and Pain Medicine, †Department of Surgery, and ‡Office of Biostatistics, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Jin-Soo
authors.initials: JS
authors.lastname: Kim
authors.forename: Jeonghun
authors.initials: J
authors.lastname: Lee
authors.forename: Euy-Young
authors.initials: EY
authors.lastname: Soh
authors.forename: Hyoeun
authors.initials: H
authors.lastname: Ahn
authors.forename: Sang Eon
authors.initials: SE
authors.lastname: Oh
authors.forename: Jung-Dong
authors.initials: JD
authors.lastname: Lee
authors.forename: Han Bum
authors.initials: HB
authors.lastname: Joe
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D066008:Cervical Plexus Block / Q000009:adverse effects; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage; D005260:Female; D006801:Humans; D020911:Ketorolac Tromethamine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D056910:Republic of Korea; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000701:Analgesics, Opioid; D016861:Cyclooxygenase Inhibitors; D020911:Ketorolac Tromethamine