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Zhang W, Zhang M, Han Y, Liu Y, Liu Y, Sun C. Combined acupuncture-medicine anesthesia used in thyroid surgery: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e32582. [PMID: 36607887 PMCID: PMC9829295 DOI: 10.1097/md.0000000000032582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Combined acupuncture-medicine anesthesia (CAMA) is extensively used in thyroid surgery in China. We conducted a systematic review and meta-analysis to assess the efficacy and safety of CAMA. METHODS We searched the China National Knowledge Infrastructure (CNKI), VIP database, WanFang database, PubMed, EMBASE, and the Cochrane Library for relevant literature. The term of literature was published before April 18, 2020, and there were no restrictions on publication language, region, or publication year. The inclusion criteria included a randomized controlled trial (RCT) of acupuncture combined with cervical plexus anesthesia. We used RevMan5.3 software for data analysis. If the chi-square test showed no significant heterogeneity (P > .10, I2 < 50%), we used the fixed-effect model to calculate risk ratio (RR) and mean difference. Otherwise, the random-effects model was used. RESULTS Overall, 18 RCTs involving 1211 patients were included in the study. The anesthesia significant rate (ASR) in the transcutaneous electrical acupoint stimulation (TEAS) plus cervical plexus block anesthesia (CPBA) and electroacupuncture (EA) plus CPBA groups was significantly higher compared with the CPBA group (TEAS + CPBA: P < .001; EA + CPBA: P < .001). The pooled effect values of the intraoperative heart rate (HR) and mean arterial pressure (MAP) were significantly lower in both the TEAS + CPBA and EA + CPBA groups relative to the control group (HR: P = .05, P < .001; the MAP: P = .002, P < .001; respectively). Moreover, the postoperative adverse reaction was markedly lower in the experimental group than in the control group (RR = 0.30, P < .001), and there was no heterogeneity between the two groups (P = .71, I2 = 0%). CONCLUSION Combined acupuncture-medicine anesthesia significantly increases the anesthesia significance rate, reduces the intraoperative heart rate, and blood pressure, and reduces the incidence of postoperative adverse reactions. However, more high-quality future studies should be conducted to validate the efficacy and safety of acupuncture combined anesthesia further.
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Affiliation(s)
- Wei Zhang
- Department of Endocrinology, The Third Affiliated Hospital of Anhui Medical University (Heifei First People’s Hospital), Hefei, China
| | - Meng Zhang
- Department of Endocrinology, The Third Affiliated Hospital of Anhui Medical University (Heifei First People’s Hospital), Hefei, China
| | | | | | - Yehai Liu
- First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chunping Sun
- Department of Endocrinology, The Third Affiliated Hospital of Anhui Medical University (Heifei First People’s Hospital), Hefei, China
- *Correspondence: Chunping Sun, Department of Endocrinology, The Third Affiliated Hospital of Anhui Medical University (Heifei First People’s Hospital), 390 Huaihe Road, Hefei 230061, China (e-mail: )
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Kobayashi K, Ikeda A, Matsumoto Y, Matsumura S, Omura G, Eguchi K, Sakai A, Ito A, Matsumoto F, Yoshimoto S. Surgical technique for superselective neck dissection under local anesthesia in recurrent head and neck cancer. Head Neck 2022; 44:1991-1994. [PMID: 35470928 DOI: 10.1002/hed.27071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/02/2022] [Accepted: 04/19/2022] [Indexed: 11/11/2022] Open
Abstract
The aim of this paper is to describe a safe and effective surgical technique for neck dissection under local anesthesia. An increasing number of patients cannot undergo general anesthesia due to systemic complication arising from old age. Moreover, the long-term survival of patients with recurrent or metastatic cancer due to advances in chemotherapy has increased the necessity of neck dissection under local anesthesia. Appropriate pain control and selection of medical devices are important factors for success of the surgery under local anesthesia. In addition to the usual subcutaneous infiltration anesthesia for pain control, nerve blocks for each cervical nerve encountered during surgery are extremely effective. Since muscle relaxants are not available, sharp devices such as knife or scissors, instead of electric scalpel, should be used to prevent unexpected muscle contractions caused by electric current. This video presents well-proven techniques and technical tips for superselective neck dissection under local anesthesia.
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Affiliation(s)
- Kenya Kobayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan.,Department of Otolaryngology - Head and Neck Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Atsuo Ikeda
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshifumi Matsumoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Satoko Matsumura
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Go Omura
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kohtaro Eguchi
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Azusa Sakai
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Akiko Ito
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
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Makovac P, Potié A, Roukain A, Pucci L, Rutz T, Kopp PA, Matter M. Hypnosis and superficial cervical anesthesia for total thyroidectomy in a high-risk patient - A case report. Int J Surg Case Rep 2020; 72:133-136. [PMID: 32535527 PMCID: PMC7298319 DOI: 10.1016/j.ijscr.2020.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 11/06/2022] Open
Abstract
Total thyroidectomy can be challenging in high-risk patients. Local superficial anesthesia combined with a hypnosis-analgesia technique instead of intravenous sedation. Because of difficulties controlling the thyrotoxic state. Given the multiple cardiac and large vessel malformations, a possible variant of the inferior laryngeal nerve was expected. Locoregional deep cervical anesthesia can be associated with breathing problems when performed bilaterally.
Introduction Total thyroidectomy can be challenging in high-risk patients. Local cervical anesthesia with sedation is an alternative to general anesthesia. Case presentation A 33-year old male patient with cyanotic congenital heart disease due to unrepaired tricuspid atresia type Ic and associated pulmonary arterial hypertension presented with tachycardic atrial fibrillation and amiodarone-induced thyrotoxicosis resulting in recurrent hemodynamic instability. Because of difficulties controlling the thyrotoxic state, the indication for total thyroidectomy was established. Total thyroidectomy was subsequently performed using local anesthesia combined using a hypnosis-analgesia technique instead of intravenous sedation. The intervention and the post-operative course were uneventful. Discussion A well-established therapist-patient relationship is crucial for a successful induction of hypnosis. Patient motivation and expectations are equally important for a successful implementation of this approach. Conclusion We conclude that hypnosis combined with local anesthesia provides an effective alternative in selected patients with very high anesthesiological risk.
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Affiliation(s)
- P Makovac
- Department of Visceral Surgery, University Hospital of Lausanne and University of Lausanne Switzerland.
| | - A Potié
- Department of Anesthesiology, University Hospital of Lausanne and University of Lausanne Switzerland
| | - A Roukain
- Division of Endocrinology, Diabetology and Metabolism, University Hospital of Lausanne and University of Lausanne Switzerland
| | - L Pucci
- Service of Cardiology, University Hospital of Lausanne and University of Lausanne Switzerland
| | - T Rutz
- Service of Cardiology, University Hospital of Lausanne and University of Lausanne Switzerland
| | - P A Kopp
- Division of Endocrinology, Diabetology and Metabolism, University Hospital of Lausanne and University of Lausanne Switzerland
| | - M Matter
- Department of Visceral Surgery, University Hospital of Lausanne and University of Lausanne Switzerland
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Thyroidectomy using superficial cervical block: a report of 147 cases over 8 years. Eur Surg 2019. [DOI: 10.1007/s10353-019-00607-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Haugen TW, Andera LN, LaMadrid AB. Awake thyroidectomy. Laryngoscope 2019; 130:685-690. [DOI: 10.1002/lary.28196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/12/2019] [Accepted: 07/05/2019] [Indexed: 11/08/2022]
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Sellami M, Feki S, Triki Z, Zghal J, Zouche I, Hammami B, Charfeddine I, Chaari M, Ghorbel A. Bupivacaine wound infiltration reduces postoperative pain and analgesic requirement after thyroid surgery. Eur Arch Otorhinolaryngol 2018. [DOI: 10.1007/s00405-018-4933-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Elmaddawy AEA, Mazy AE. Ultrasound-guided bilateral superficial cervical plexus block for thyroid surgery: The effect of dexmedetomidine addition to bupivacaine-epinephrine. Saudi J Anaesth 2018; 12:412-418. [PMID: 30100840 PMCID: PMC6044169 DOI: 10.4103/sja.sja_653_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The thyroid gland surgery is a common and painful procedure demanding analgesia. Many regional techniques are applied for anterior neck surgeries mostly assigned in relation to the involved cervical fascia. Dexmedetomidine (Precedex) is a selective alpha 2 adrenoceptor agonist which prolongs the sensory blockade duration of local anesthetics. Our study hypothesis is that ultrasound (US)-guided bilateral superficial cervical plexus block (BSCPB) may provide longer analgesia when adding dexmedetomidine to bupivacaine-epinephrine. Purpose: The aim of this study is to evaluate the analgesic efficacy and possible side effects of US-guided BSCPB and the effect of dexmedetomidine addition to bupivacaine-epinephrine in patients undergoing thyroid surgery. Methods: This prospective, double-blind, randomized study was performed on 42 patients randomized into two equal groups each of 21; bupivacaine Group B and dexmedetomidine Group D. Patients with contraindications to regional anesthesia or uncontrolled comorbidities were excluded from the study. Total pethidine consumption in 24 h is the primary outcome. The visual analog scale, timing of the first opioid request, and hemodynamics are the secondary outcomes. Results: In Group D, there was a longer time to the first request of opioid postoperatively, a lower total pethidine consumption and pain score postoperatively, and lower fentanyl requirements intraoperatively. Conclusions: Sonographic-guided bilateral SCPB using a combination of bupivacaine, dexmedetomidine, and epinephrine was superior to bupivacaine for prolonged analgesia with less intra- and postoperative opioid consumption and lower side effect profile during thyroid surgery.
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Affiliation(s)
- Alaa Eldin Adel Elmaddawy
- Department of Anesthesia, Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Alaa Eldin Mazy
- Department of Anesthesia, Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Kim MS, Kim BH, Han YE, Nam DW, Hah JH. Clinical outcomes after local anesthesia with monitored anesthesia care during thyroidectomy and selective neck dissection: a randomized study. Eur Arch Otorhinolaryngol 2017; 274:3789-3794. [DOI: 10.1007/s00405-017-4707-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/08/2017] [Indexed: 10/19/2022]
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9
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Kim SE, Kim E. Local anesthesia with monitored anesthesia care for patients undergoing thyroidectomy: a case series. Korean J Anesthesiol 2016; 69:635-639. [PMID: 27924208 PMCID: PMC5133239 DOI: 10.4097/kjae.2016.69.6.635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/25/2016] [Accepted: 05/27/2016] [Indexed: 11/10/2022] Open
Abstract
Because the current trend favors minimally invasive surgery for thyroid disease, increasing interest has developed for thyroidectomy under local anesthesia with monitored anesthesia care (MAC). Here, we retrospectively reviewed 18 cases of thyroidectomy performed under local anesthesia with MAC in a single center. All of the procedures were performed by a single surgeon, using local lidocaine infiltration around the incisional site and propofol plus remifentanil target-controlled infusion. Sore throat (4/18), hypocalcemia (1/18), and transient voice color change (1/18) were observed, but the patients recovered during the follow-up period. No cases of postoperative nausea and vomiting, hematoma, wound problems, or vocal cord paralysis were observed. Local anesthesia with MAC provided satisfactory sedation in most patients without conversion to general anesthesia.
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Affiliation(s)
- Se Eun Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eugene Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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Kabade S, Bhosale R, Karthik SL. Case of limb-girdle muscular dystrophy for total thyroidectomy: Anaesthetic management. Indian J Anaesth 2016; 60:358-60. [PMID: 27212726 PMCID: PMC4870952 DOI: 10.4103/0019-5049.181611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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U. P S, K. B P, Mohammed SJ, Pereira NJ, Gupta S, K. R S, K. M T. Thyroidectomy Under Regional Anaesthesia: An ORL Perspective. J Clin Diagn Res 2015; 9:MC01-4. [PMID: 26557548 PMCID: PMC4625267 DOI: 10.7860/jcdr/2015/16055.6617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 08/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The use of regional anaesthesia as an effective alternative to general anaesthesia in thyroid surgeries is now being accepted in many parts of the world. In this day of computers and technology, there is an increased awareness among the people of the available options of anaesthesia and the adverse effects of general anaesthesia. They thus have an inclination to avoid general anaesthesia wherever feasible. This study dwells on the use of regional anaesthesia as an alternative tool that can be offered to the patients undergoing thyroidectomy. AIMS This study aims at analysing the effectiveness, safety, ease and patient acceptability of performing thyroidectomies under regional anaesthesia. SETTINGS AND DESIGN This prospective study was performed at a university - affiliated hospital. MATERIALS AND METHODS Twenty nine patients who underwent thyroidectomy for benign thyroid diseases under regional anaesthesia were included in this study: 20 patients under deep cervical plexus block and 9 patients under cervical epidural anaesthesia. STATISTICAL ANALYSIS USED Z-test and validity test. RESULTS In our study, all the 29 patients who underwent thyroidectomy under regional anaesthesia found the anaesthesia effective and were comfortable throughout the procedure. The surgeon too was at ease while performing the surgery. No complications were recorded. CONCLUSION In our present study, regional anaesthesia (Cervical epidural anaesthesia and Cervical plexus block) has been used safely and effectively in 29 thyroid surgeries. We conclude that although regional anaesthesia has been reserved for high risk thyroidectomies it may be offered as effective alternative to general anaesthesia even in routine thyroid surgeries.
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Affiliation(s)
- Santosh U. P
- Professor, Department of ENT and Head & Neck Surgery, JJM Medical college, Davangere, Karnataka, India
| | - Prashanth K. B
- Professor and Unit Chief, Department of ENT and Head & Neck surgery, JJM Medical college, Davangere, Karnataka, India
| | - Shamna J. Mohammed
- Postgraduate, Department of ENT and Head & Neck Surgery, JJM Medical College, Davangere, Karnataka, India
| | - Nivedeeta J. Pereira
- Postgraduate, Department of ENT and Head & Neck Surgery, JJM Medical College, Davangere, Karnataka, India
| | - Srijoy Gupta
- Postgraduate, Department of ENT and Head & Neck Surgery, JJM Medical College, Davangere, Karnataka, India
| | - Sumanth K. R
- Postgraduate, Department of ENT and Head & Neck Surgery, JJM Medical College, Davangere, Karnataka, India
| | - Triveni K. M
- Postgraduate, Department of ENT and Head & Neck Surgery, JJM Medical College, Davangere, Karnataka, India
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Dumlu EG, Tokaç M, Öcal H, Durak D, Kara H, Kılıç M, Yalçın A. Local bupivacaine for postoperative pain management in thyroidectomized patients: A prospective and controlled clinical study. ULUSAL CERRAHI DERGISI 2015; 32:173-7. [PMID: 27528810 DOI: 10.5152/ucd.2015.3138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/14/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We aimed to evaluate the effect of bupivacaine and to compare the routes of administration of bupivacaine in the management of postoperative incision site pain after thyroidectomy. MATERIAL AND METHODS Consecutive patients who were planned for thyroidectomy surgery were randomized into three groups of 30 patients each: Group 1 (control group): standard thyroidectomy surgery without additional intervention; Group 2 (paratracheal infiltration with bupivacaine): following thyroidectomy, 0.25% bupivacaine was applied on the surgical area; Group 3 (subcutaneous infiltration with bupivacaine): following thyroidectomy, 0.25% bupivacaine was injected into the cutaneous, subcutaneous region and fascia of the surgical area. Postoperative pain was evaluated by a visual analog scale (VAS) at 1(st), 4(th), and 12(th) hours after thyroidectomy. Total daily requirement for additional analgesia was recorded. RESULTS The mean age of 90 patients was 44.37±13.42 years, and the female:male ratio was 62:28. There was no difference between study groups in terms of age, thyroid volume, TSH and T4 levels. VAS score of patients in paratracheal infiltration with bupivacaine group was significantly lower than control group patients at 1(st), 4(th) and 12(th) hours following thyroidectomy (p=0.030, p=0.033, p=0.039, respectively). The need for analgesics was significantly lower in both paratracheal infiltration and subcutaneous infiltration groups than the control group (86.7%, 83.0%, and 73.3%, respectively, p=0.049). CONCLUSIONS Intraoperative local bupivacaine application is effective in decreasing postoperative pain in patients with thyroidectomy.
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Affiliation(s)
- Ersin Gürkan Dumlu
- Clinic of General Surgery, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Mehmet Tokaç
- Clinic of General Surgery, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Haydar Öcal
- Clinic of General Surgery, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Doğukan Durak
- Clinic of General Surgery, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Halil Kara
- Department of Pharmacology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Mehmet Kılıç
- Department of General Surgery, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Abdussamed Yalçın
- Department of General Surgery, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
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Wang Q, Li Z, Xu S, Li Y, Zhang X, Liu Q, Xia Y, Papadimos TJ, Xu X. Feasibility of ultrasound-guided capsule-sheath space block combined with anterior cervical cutaneous nerves block for thyroidectomy: an observational pilot study. BMC Anesthesiol 2015; 15:4. [PMID: 25670918 PMCID: PMC4322798 DOI: 10.1186/1471-2253-15-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/12/2015] [Indexed: 11/30/2022] Open
Abstract
Background We evaluated the efficacy of a new anesthetic technique termed ultrasound-guided capsule-sheath space block (CSSB) combined with anterior cervical cutaneous nerve block (CCNB) for thyroidectomy. Methods The study included two parts: Part one was an imaging study to determine technique feasibility. The CSSB was performed on five healthy volunteers by introducing the needle 0.5 cm lateral to the probe under in-plane needle ultrasound guidance. After puncture of the false capsule and its subsequent contraction with the true capsule of thyroid, 10 mL of contrast medium was deposited slowly in the capsule-sheath space. The CCNB was performed bilaterally as follows: Under ultrasound guidance, a subcutaneous injection was made along the sternocleidomastoid using 10 mL of contrast medium which was followed by a girdle-shaped picchu raised from the cricoid cartilage to supraclavicular region. The spreading pattern of contrast medium was imaged using computed tomographic scanning. In part two (a clinical case series) the technique efficacy was evaluated. Seventy-eight patients undergoing thyroidectomy had ultrasound-guided CSSB and CCNB with local anesthetics. The sensory onset of CCNB, intraoperative hemodynamic parameters, and analgesic effect were assessed and complications were noted. Results The distribution of contrast medium was well defined. In part two the onset time of CCNB was 2.2 ± 0.7 min, and the hemodynamic parameters remained stable intraoperatively. The recall of visual analogue scale scores during surgery was 2 [1–4] for median (range). The patients’ and surgeons’ satisfaction scores were 2 [1–4] and 1 [1–3] for median (range). No serious complications occurred. Conclusions Combining ultrasound-guided CSSB and CCNB is a feasible, effective and safe technique for thyroidectomy. Trial registration Current Controlled Trials ChiCTR-ONC-12002025. Registered 19 March 2012.
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Affiliation(s)
- Quanguang Wang
- Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Zhejiang, China
| | - Zhengqian Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Shihao Xu
- Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Zhejiang, China
| | - Yu Li
- Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Zhejiang, China
| | - Xuezheng Zhang
- Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Zhejiang, China
| | - Qimin Liu
- Department of Anesthesiology, Yongjia People's Hospital, Zhejiang, China
| | - Yun Xia
- Department of Anesthesiology, Ohio State University Medical Center, Ohio, USA
| | - Thomas J Papadimos
- Department of Anesthesiology, Ohio State University Medical Center, Ohio, USA
| | - Xuzhong Xu
- Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Zhejiang, China
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Capek S, Tubbs RS, Spinner RJ. Do cutaneous nerves cross the midline? Clin Anat 2014; 28:96-100. [DOI: 10.1002/ca.22427] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 01/23/2023]
Affiliation(s)
- Stepan Capek
- Department of Neurosurgery; Mayo Clinic; Rochester Minnesota
- International Clinical Research Center, St. Anne's University Hospital Brno; Brno Czech Republic
| | - R. Shane Tubbs
- Division of Pediatric Neurosurgery; Children's Hospital; Birmingham Alabama
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Alabdulkarim Y, Nassif E. Safety and success of parathyroidectomy under local anaesthesia with the classical anterior cervical approach. J Taibah Univ Med Sci 2013. [DOI: 10.1016/j.jtumed.2013.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bendinelli C, Nebauer S, Quach T, Mcgrath S, Acharya S. Is minimally invasive parathyroid surgery an option for patients with gestational primary hyperparathyroidism? BMC Pregnancy Childbirth 2013; 13:130. [PMID: 23758620 PMCID: PMC3691590 DOI: 10.1186/1471-2393-13-130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/24/2013] [Indexed: 11/15/2022] Open
Abstract
Background Gestational primary hyperparathyroidism is associated with serious maternal and neonatal complications, which require prompt surgical treatment. Minimally invasive parathyroidectomy reduces pain, improves cosmesis and may achieve cure rates comparable to traditional open bilateral neck exploration. We report the clinical course of a woman with newly diagnosed gestational primary hyperparathyroidism and discuss the decision making behind the choice of video-assisted minimally invasive parathyroidectomy, amongst the other minimally invasive parathyroidectomy techniques available. Case presentation A 38-years-old pregnant woman at 9 weeks of gestation, with severe hyperemesis and hypercalcaemia secondary to gestational primary hyperparathyroidism (ionised calcium 1.28 mmol/l) was referred for surgery. Ultrasound examination of her neck identified 2 suspicious parathyroid enlargements. In view of pregnancy, a radioisotope Sestamibi parathyroid scan was not performed. Bilateral four-gland exploration was therefore deemed necessary to guarantee cure. This was performed with video-assisted minimally invasive parathyroidectomy, which relies on a single 15 mm central incision with external retraction and endoscopic magnification, allowing bilateral neck exploration. Surgery was performed at 23 weeks of gestation. Four glands were identified in orthotopic positions of which three had normal appearance. The fourth was a right superior parathyroid adenoma of 756 mg. Ionized calcium (1.12 mmol/l) and PTH (0.9 pmol/l) normalised postoperatively. Patient was discharged on the second postoperative day, needing no pain relief. Cosmetic result was excellent. Her pregnancy progressed normally and she delivered a healthy baby. Conclusion Video-assisted minimally invasive parathyroidectomy allows bilateral four-gland exploration, and is an optimal technique to treat gestational primary hyperparathyroidism. This procedure removes the need for radiation exposure, reduces pain, improves cosmesis and may achieve cure rates comparable to traditional open bilateral neck exploration.
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Warschkow R, Tarantino I, Jensen K, Beutner U, Clerici T, Schmied BM, Steffen T. Bilateral superficial cervical plexus block in combination with general anesthesia has a low efficacy in thyroid surgery: a meta-analysis of randomized controlled trials. Thyroid 2012; 22:44-52. [PMID: 22142371 DOI: 10.1089/thy.2011.0260] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A combination of bilateral superficial cervical plexus block (BSCPB) and general anesthesia is recommended for thyroid surgery. Proof of the efficacy of this combination remains weak. Furthermore, data on the safety of this regimen are lacking. Therefore, a meta-analysis of randomized controlled trials (RCT) to evaluate the efficacy and safety of BSCPB as an adjunct to general anesthesia in patients receiving thyroid surgery was performed. METHODS A meta-analysis of RCT was performed that included interventional groups evaluating the efficacy of BSCPB 6 and 24 hours after thyroid surgery. RESULTS Eight RCT, including a total of 799 patients (463 who underwent BSCPB and 336 controls), were analyzed. A meta-analysis demonstrated a reduction in pain scores 6 hours (Hedges' g: -0.46 [95% CI: -0.74 to -0.19]; p=0.001) and 24 hours postoperatively (Hedges' g: -0.49 [95% CI: -0.71 to -0.27]; p<0.001) in patients who had undergone BSCPB. The relative risk for postoperative nausea and vomiting (PONV) was 0.80 (95% CI: 0.58 to 1.09, p=0.159) in patients receiving BSCPB. Procedure-related adverse events were reported in three of the 476 patients who had undergone BSCPB (0.6%; 95% CI: 0.1% to 2.0%). These three patients had transient paresis of the brachial plexus, combined with a diaphragmatic paresis in one case, and all spontaneously resolved. CONCLUSION The combination of BSCPB and general anesthesia has a significant benefit in reducing pain 6 and 24 hours after thyroid surgery. However, the effect on pain reduction is too small to be of clinical relevance. Although it is a safe procedure, the existing evidence allows for no recommendation concerning the application of BSCPB in thyroid surgery. Further trials should evaluate a dose-response relationship and the incidence of PONV with this regimen.
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Affiliation(s)
- Rene Warschkow
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Local anesthesia in thyroid surgery--own experience and literature review. POLISH JOURNAL OF SURGERY 2011; 83:264-70. [PMID: 22166479 DOI: 10.2478/v10035-011-0041-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED The local anesthesia in thyroid surgery is rarely used, only in selected patients. Majority of centers performing thyroid surgery with local anesthesia have possibility to convert to the general anesthesia. The aim of the study was to present our experiences with partial thyroidectomy under local anesthesia performed in 49 consecutive subjects in the Central African Republic (bilateral subtotal strumectomy, total resection of the one lobe, subtotal resection of the one lobe). MATERIAL AND METHODS All admitted patients with clinically significant goiter were accepted for surgical treatment. For infiltration anesthesia 1% lignocaine was used. Because of the shortage of medical resources, potential conversion to the general anesthesia was impossible. Before the operation patients had received an oral sedation and antibiotic. In 16 patients general anesthesia was used, in other 33 it was impossible. RESULTS Subtotal bilateral thyroidectomy was performed in 37 patients, 12 patients underwent lobectomy or partial lobectomy of the affected portion of the gland. There were no intraoperative and postoperative complications noticed in the reported group, including complications related to laryngeal nerve injury. The mean duration of the procedure was 127 minutes and mean medical follow-up was 3 days. General condition of all patients on the day of discharge from hospital was good. CONCLUSIONS Surgery for goiter under local anesthesia may be a safe alternative where general anesthesia is not available or contraindicated for medical reasons. The infiltration anesthesia is simple to perform and reduces the number of complications potentially occurred at the C2-C4 neck plexus block.
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Shih ML, Duh QY, Hsieh CB, Liu YC, Lu CH, Wong CS, Yu JC, Yeh CC. Bilateral superficial cervical plexus block combined with general anesthesia administered in thyroid operations. World J Surg 2011; 34:2338-43. [PMID: 20623224 PMCID: PMC2939771 DOI: 10.1007/s00268-010-0698-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background We investigated the analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy and to determine whether it reduces the adverse effects of general anesthesia. Methods We prospectively recruited 162 patients who underwent elective thyroid operations from March 2006 to October 2007. They were randomly assigned to receive a bilateral superficial cervical block (12 ml per side) with isotonic saline (group A; n = 56), bupivacaine 0.5% (group B; n = 52), or levobupivacaine 0.5% (group C; n = 54) after induction of general anesthesia. The analgesic efficacy of the block was assessed with: intraoperative anesthetics (desflurane), numbers of patients needing postoperative analgesics, the time to the first analgesics required, and pain intensity by visual analog scale (VAS). Postoperative nausea and vomiting (PONV) for 24 h were also assessed by the “PONV grade.” We also compared hospital stay, operative time, and discomfort in swallowing. Results There were no significant differences in patient characteristics. Each average end-tidal desflurane concentration was 5.8, 3.9, and 3.8% in groups A, B, and C, respectively (p < 0.001). Fewer patients in groups B and C required analgesics (A: B: C = 33:8:7; p < 0.001), and it took longer before the first analgesic dose was needed postoperatively (group A: B: C = 82.1:360.8:410.1 min; p < 0.001). Postoperative pain VAS were lower in groups B and C for the first 24 h postoperatively (p < 0.001). Incidences of overall and severe PONV were lower, however, there were not sufficient numbers of patients to detect differences in PONV among the three groups. Hospital stay was shorter in group B and group C (p = 0.011). There was no significant difference in operative time and postoperative swallowing pain among the three groups. Conclusions Bilateral superficial cervical plexus block reduces general anesthetics required during thyroidectomy. It also significantly lowers the severity of postoperative pain during the first 24 h and shortens the hospital stay.
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Affiliation(s)
- Ming-Lang Shih
- Division of General Surgery, Department of Surgery, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
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Anesthetic considerations in a patient with amiodarone-induced thyrotoxicosis. Case Rep Med 2010; 2010:984981. [PMID: 20592999 PMCID: PMC2892708 DOI: 10.1155/2010/984981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 03/23/2010] [Accepted: 05/12/2010] [Indexed: 11/21/2022] Open
Abstract
Amiodarone-induced thryrotoxicosis (AIT) is a rare but serious complication of amiodarone use, especially in patients with severe cardiac disease. We present a patient who developed AIT, following administration of amiodarone for life-threatening ventricular arrhythmias. We discuss the medical management of AIT and anesthetic considerations for management of patients with thyrotoxicosis and severe cardiac disease who require surgery including thyroidectomy.
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Suri K, Hunter C, Davidov T, Anderson M, Dombrovskiy V, Trooskin S. Postoperative Recovery Advantages in Patients Undergoing Thyroid and Parathyroid Surgery Under Regional Anesthesia. Semin Cardiothorac Vasc Anesth 2010; 14:49-50. [DOI: 10.1177/1089253210363010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thyroid or parathyroid surgery may be performed using general anesthesia or regional anesthesia. Ninety-five (95) patients underwent thyroid or parathyroid surgery using general anesthesia (n=64) or bilateral superficial cervical plexus block with sedation (n=31) and completed a postoperative questionnaire regarding the perioperative experience. Patients undergoing parathyroid surgery under regional anesthesia (n=24) were more likely to experience better energy levels (p=0.012) and earlier return to work (p=0.045) postoperatively. Overall, 96% of patients undergoing either type of surgery with either type of anesthetic reported satisfaction with the anesthetic.
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Affiliation(s)
- K.B. Suri
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - C.W. Hunter
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA,
| | - T. Davidov
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - M.B. Anderson
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - V. Dombrovskiy
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - S.Z. Trooskin
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Cregg R, Raghuraman T, Green D, Windsor J. Thyroid surgery: what are the options for anaesthesia? Br J Hosp Med (Lond) 2008; 69:424. [PMID: 18833986 DOI: 10.12968/hmed.2008.69.7.30428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Roman Cregg
- Department of Anaesthetics, University College London Hospitals, London
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