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Kamel AAF, Fahmy AM, Fathi HM, Elmesallamy WAEA, Khalifa OYA. Regional analgesia using ultrasound-guided intermediate cervical plexus block versus cervical erector spinae block for anterior cervical spine surgery: a randomized trial. BMC Anesthesiol 2024; 24:153. [PMID: 38649826 PMCID: PMC11034160 DOI: 10.1186/s12871-024-02533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Regional analgesia techniques are crucial for pain management after cervical spine surgeries. Anesthesiologists strive to select the most effective and least hazardous regional analgesia technique for the cervical region. Our hypothesis is that an intermediate cervical plexus (IC) block can provide adequate postoperative analgesia compared to a cervical erector spinae (ES) block in patients undergoing anterior cervical spine surgery. METHODS In this double-blind prospective trial, 58 patients were randomly assigned into two equal groups prior to the administration of general anesthesia. Patients in the IC group (n = 29) underwent ultrasound-guided bilateral intermediate cervical plexus block with 15 ml of bupivacaine 0.25% administered to each side. The ES group (n = 29) underwent ultrasound-guided bilateral cervical erector spinae plane blocks with 15 ml of 0.25% bupivacaine administered to each side at the C6 level. The primary outcome was to record the time to the first call for rescue analgesia (nalbuphine), and the secondary outcomes were to measure the performance time, the onset of the sensory block, the intraoperative fentanyl consumption, postoperative pain intensity using VAS, the postoperative total nalbuphine consumption, and postoperative complications such as nausea, vomiting, hypotension, and bradycardia. RESULTS The performance and onset of sensory block times were significantly shorter in the IC group compared to the ES group. The time to first call for nalbuphine was significantly shorter in the IC group (7.31 ± 1.34 h) compared to the ES group (11.10 ± 1.82 h). The mean postoperative VAS scores were comparable between the two groups at the measured time points, except at 8 h, where it was significantly higher in the IC group, and at 12 h, where it was significantly higher in the ES group. The total nalbuphine consumption was significantly higher in the IC group (33.1 ± 10.13 mg) compared to the ES group (22.76 ± 8.62 mg). CONCLUSIONS For patients undergoing anterior cervical spine surgery, the intermediate cervical plexus block does not provide better postoperative regional analgesia compared to the cervical erector spinae block. Performance time and onset time were shorter in the IC group, whereas nalbuphine consumption was lower in the ES group. TRIAL REGISTRATION The trial was registered at clinicaltrials.gov. (NCT05577559, and the date of registration: 13-10-2022).
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Affiliation(s)
- Alshaimaa Abdel Fattah Kamel
- Anaesthesia, Intensive Care and Pain Management Department, Faculty of Human Medicine, Zagazig University, Alsharkia, Egypt.
- Anesthesia, Intensive Care and Pain Management Department, Faculty of Medicine, Zagazig University, Algamaa Street, Alsharkia, Egypt.
| | - Ahmed M Fahmy
- Anaesthesia, Intensive Care and Pain Management Department, Faculty of Human Medicine, Zagazig University, Alsharkia, Egypt
| | - Heba M Fathi
- Anesthesia, Intensive Care and Pain Management Department, Faculty of Medicine, Zagazig University, Algamaa Street, Alsharkia, Egypt
| | | | - Osama Yehia A Khalifa
- Anaesthesia, Intensive Care and Pain Management Department, Faculty of Human Medicine, Zagazig University, Alsharkia, Egypt
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Yin D, Duan Z, Wang P, Zhao R, Wang S, Li X. Analgesic effects of pectoserratus plane block and intermediate cervical plexus block for transaxillary endoscopic thyroidectomy: a prospective randomized controlled trial. Minerva Anestesiol 2024; 90:263-270. [PMID: 38652449 DOI: 10.23736/s0375-9393.24.17809-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Transaxillary endoscopic thyroidectomy (TAET) is favored for its favorable cosmetic outcomes and the preservation of anterior cervical function. Despite these benefits, postoperative analgesia has traditionally relied on pharmacological interventions, and regional anesthetic procedures may be an alternative method. This study aimed to evaluate the efficacy of an ultrasound-guided pectoserratus plane block (PSPB) combined with an intermediate cervical plexus block (ICPB) for TAET. METHODS Forty patients undergoing TAET were randomized into two groups: the nerve block group (N.=20) received ultrasound guided PSPB with 20 ml of 0.375% ropivacaine and ICPB with 8 mL of 0.3% ropivacaine, while the control group (N.=20) received no block. The primary outcome was the Visual Analog Scale (VAS) scores for postoperative neck and axillary pain at different time points (1, 6, 12, 24 h) during rest and movement post-TAET. The secondary outcomes included intraoperative remifentanil consumption, incidence of postoperative nausea and vomiting (PONV), number of remedial analgesic requirements, and patient satisfaction postoperatively. RESULTS Compared to the control group, patients in the nerve block had significantly lower VAS scores of the neck and axilla whether at rest or movement, and 1, 6, 12, and 24 h postoperatively (P<0.0125). The nerve block group showed higher patient satisfaction (P<0.001). No difference was observed in intraoperative remifentanil consumption, need for rescue analgesics, or other adverse effects 48 h postoperatively. CONCLUSIONS Ultrasound-guided PSPB with ICPB significantly alleviated postoperative pain and improved patient satisfaction with TAET.
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Affiliation(s)
- Dong Yin
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China
| | - Zongsheng Duan
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China
| | - Peisong Wang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
| | - Ruyan Zhao
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China
| | - Shuang Wang
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China
| | - Xinbai Li
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China -
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Chen X, Han C, Li D, Zhu F, Huang Y. Achieving the minimum pain experience by buccal nerve and superficial cervical plexus blocks in radiofrequency treatment. J Cosmet Dermatol 2024; 23:470-478. [PMID: 37878546 DOI: 10.1111/jocd.16025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/22/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Thermage is a monopolar radiofrequency (RF). It has become an indispensable part of facial and body youthful methods. Although the current device is constantly improving in epidermal cooling techniques and even automatically measures the local impedance value, applying surface anesthesia can take some of the pain away caused by thermage, and the patient's severe pain in the jaw and neck areas is still difficult to resolve. METHODS The author describes how he uses the combination of the buccal nerve block (BNB) and the superficial cervical plexus block (SCPB) to improve the comfort of the patient's face and neck treatment of patients. It can improve the quality, elasticity, and texture of the skin. RESULTS According to the author's knowledge of oral and maxillofacial surgery, the combination of BNB and SCPB is applied to the neck and facial analgesia. Combining the BNB and SCPB effectively provides facial and neck anesthesia. The BNB in this technique provides pain relief to the facial skin in the mandibular area and SCPB offers pain relief to the skin of the neck. RF facial rejuvenation treatment often involves the junction of the face and neck to improve the contour of the mandibular margin. Therefore, Whether the RF treatment is aimed at the face or neck, or the treatment is performed simultaneously, we advocate the block both of the buccal nerve and the superficial cervical plexus nerves to achieve perfect analgesia. Still, the dosage of anesthetic medication for the nerve block can be adjusted according to the treatment area. CONCLUSION We applied these two nerve blocks and their combination to improve skin laxity with RF therapy for the first time.
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Affiliation(s)
- Xihua Chen
- Suzhou Industrial Park Huibang Zhimei Medical Beauty Clinic Co., Ltd, Jiangsu, Suzhou, P. R. China
| | - Changzhu Han
- Suzhou Industrial Park Huibang Zhimei Medical Beauty Clinic Co., Ltd, Jiangsu, Suzhou, P. R. China
| | - Dan Li
- Suzhou Industrial Park Huibang Zhimei Medical Beauty Clinic Co., Ltd, Jiangsu, Suzhou, P. R. China
| | - Feiling Zhu
- Suzhou Industrial Park Huibang Zhimei Medical Beauty Clinic Co., Ltd, Jiangsu, Suzhou, P. R. China
| | - Ying Huang
- Surgical Anesthesiology, Guangxi Medical University College of Stomatology, Guangxi, Nanning, P. R. China
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Liu Z, Bi C, Li X, Song R. The efficacy and safety of opioid-free anesthesia combined with ultrasound-guided intermediate cervical plexus block vs. opioid-based anesthesia in thyroid surgery-a randomized controlled trial. J Anesth 2023; 37:914-922. [PMID: 37740124 PMCID: PMC10654206 DOI: 10.1007/s00540-023-03254-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE In the context of the current comfort medicine and enhanced recovery after surgery, there is a demand for a new anesthesia method to reduce adverse reactions and accelerate recovery after surgery. This randomized controlled trial aimed to compare the efficacy and safety between opioid-free anesthesia (OFA) combined with ultrasound-guided intermediate cervical plexus block (ICPB) and opioid-based anesthesia in patients after thyroid surgery. METHODS In this study, 75 patients scheduled for thyroid surgery under general anesthesia were randomly allocated into two groups. The primary outcome included the incidence of nausea within 24 h after surgery. The main secondary outcomes included the incidence of vomiting and the visual analog score (VAS) scores within 24 h after surgery as well as the quality of recovery 40 questionnaires (QoR-40) scores 24 h after surgery. RESULTS In the OFA group, the incidence of postoperative nausea was 6.1%, compared to 39.4% in the control group (p = 0.001). No patient presented with postoperative vomiting in the OFA group, while 15.2% of patients suffered from postoperative vomiting in the control group (p = 0.063). The VAS scores of patients in the postanesthetic care unit (PACU) and 2 h, 4 h, and 6 h after surgery were lower in the OFA group, and the difference is statistically significant. Besides, the VAS scores of patients at rest (p = 1.000) and during swallowing (p = 1.000) 24 h after surgery were comparable. CONCLUSION Compared with opioid-based anesthesia, the OFA combined with the ultrasound-guided ICPB can better improve patients' postoperative recovery, reduce nausea, and decrease pain scores. TRIAL REGISTRATION Chinese Clinical Trial Regisrty, ChiCTR2200056344, https://www.chictr.org.cn.
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Affiliation(s)
- Zhi Liu
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
- China Medical University, Shenyang, China
| | - Congjie Bi
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China.
| | - Xingguo Li
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Ruonan Song
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
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Abi Lutfallah A, Jabbour K, Gergess A, Hayeck G, Matar N, Madi-Jebara S. [Cervical plexus block as an alternative anesthetic approach for type I thyroplasty: a case report]. Rev Bras Anestesiol 2020; 70:556-560. [PMID: 33012560 DOI: 10.1016/j.bjan.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 07/11/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The role of type I thyroplasty (TIP) is well established as the treatment for glottal insufficiency due to vocal fold paralysis, but the ideal anesthetic management for this procedure is still largely debated. We present the case of a novel anesthetic approach for TIP using combined intermediate and superficial Cervical Plexus Block (CPB) and intermittent mild sedation analgesia. CASE REPORT A 51-year-old presenting with left vocal fold paralysis and obstructive sleep apnea was scheduled for TIP. An ultrasound-guided intermediate CPB was performed using the posterior approach, and 15 mL of ropivacaine 0.5% were injected in the posterior cervical space between the sternocleidomastoid muscle and the prevertebral fascia. Then, for the superficial CPB, a total of 10 mL 0.5% ropivacaine was injected subcutaneously, adjacently to the posterior border of the sternocleidomastoid muscle, without penetrating the investing fascia. An intermittent sedation analgesia with a target-controlled infusion of remifentanyl (target 0.5 ng.mL-1) was used to facilitate prosthesis insertion and the fiberoptic laryngoscopy. This technique offered a safe anesthetic airway and good operating conditions for the surgeon, as well as feasible voice monitoring and optimal patient comfort. CONCLUSION The use of regional technique is a promising method for the anesthetic management in TIP, especially in patients with compromised airway.
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Affiliation(s)
- Antoine Abi Lutfallah
- Saint Joseph University, School of Medicine, Hôtel-Dieu de France Hospital, Department of Anesthesia. Critical Care and Pain Management, Beirut, Líbano.
| | - Khalil Jabbour
- Saint Joseph University, School of Medicine, Hôtel-Dieu de France Hospital, Department of Anesthesia. Critical Care and Pain Management, Beirut, Líbano
| | - Afrida Gergess
- Saint Joseph University, School of Medicine, Hôtel-Dieu de France Hospital, Department of Anesthesia. Critical Care and Pain Management, Beirut, Líbano
| | - Gemma Hayeck
- Saint Joseph University, School of Medicine, Hôtel-Dieu de France Hospital, Department of Anesthesia. Critical Care and Pain Management, Beirut, Líbano
| | - Nayla Matar
- Saint Joseph University, School of Medicine, Hôtel-Dieu de France Hospital, Department of Otolaryngology Head and Neck Surgery, Beirut, Líbano
| | - Samia Madi-Jebara
- Saint Joseph University, School of Medicine, Hôtel-Dieu de France Hospital, Department of Anesthesia. Critical Care and Pain Management, Beirut, Líbano
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Petrucci E, Cofini V, Pizzi B, Coletta R, Blasetti AG, Necozione S, Fusco P, Marinangeli F. Intermediate Cervical Plexus Block in the Management of Persistent Postoperative Pain Post Carotid Endarterectomy: A Prospective, Randomized, Controlled, Clinical Trial. Pain Physician 2020; 23:237-244. [PMID: 32517389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The mechanisms of persistent postoperative pain (PPP) with neuropathic features after carotid endarterectomy (CEA) are multifaceted and are incompletely understood. OBJECTIVES The aim of this research was to assess whether the ultrasound-guided (USG) intermediate cervical plexus block (ICPB) could provide better control of PPP and neuropathic disturbances (NPDs) after CEA than the USG superficial cervical plexus block (SCPB). STUDY DESIGN Prospective, randomized, controlled, clinical trial. SETTING This clinical trial was conducted at the SS Filippo and Nicola Academic Hospital of Avezzano (L'Aquila, Italy). METHODS Patients who were scheduled for primary CEA were chosen. In the experimental group, the USG-ICPB was performed unilaterally, at the level of the third cervical vertebra. The needle was inserted into the deep lamina of the deep fascia of the neck, between the posterior border of the middle scalene muscle and the anterior border of the posterior scalene muscle. Three milliliters saline solution was injected into the opening of the deep lamina, and 20 mL 0.375% levobupivacaine was injected. In the control group, the anesthetic target was located at the inferior border of the sternocleidomastoid muscle at the level of the third cervical vertebra. The needle was superficially inserted below the skin, and 2 to 3 mL saline solution was injected into the opening of the superficial lamina of the deep fascia of the neck. A total of 20 mL 0.375% isobaric levobupivacaine was subsequently injected.The primary outcome measure was the proportion of patients with PPP on movement and at rest 3 months after surgery. The secondary outcome measures were NPD assessment scores using the von Frey hair test and the Lindblom test, opioid and pregabalin consumption. Adverse effects were also recorded. RESULTS A total of 98 consecutive patients were enrolled and randomized to receive either a USG-SCPB (control group, n = 49) or a USG-ICPB (experimental group, n = 49). The sensory blockade was longer in the experimental group. Three months after surgery, the proportions of patients with PPP on movement were significantly different between the experimental and control groups (33%, 95% confidence intervals [CI], 20%-47% vs. 71%, 95% CI, 57%-83%; P < 0.001), whereas there were no differences in the proportions of patients with pain at rest between groups (31%, 95% CI, 18%-45% vs. 49%, 95% CI, 34%-64%; P = 0.063). The proportions of patients with NPDs were not different between the groups, whereas the sizes of the areas of interest (cm2) were significantly different. LIMITATIONS A limitation of this study is that we assessed NPDs for only 3 months using the von Frey hair test and the Lindblom test without additional instrumental techniques. Additionally, there are many risk factors for NPDs after CEA. For this reason, another limitation of this research is that we neglected to consider the relationship between the choice of anesthetic block and the presence of these risk factors. CONCLUSIONS The USG-ICPB provided long-lasting analgesia during the postoperative period and might mitigate the development of NPDs, thereby decreasing the analgesic drug requirement. KEY WORDS Carotid endarterectomy, intermediate cervical plexus block, myofascial planes of neck, neuropathic disturbances, persistent postoperative pain, superficial cervical plexus blocks, ultrasound guidance, vascular disease.
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Affiliation(s)
- Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, Italy
| | - Vincenza Cofini
- Department of life health & environmental sciences, University of L'Aquila
| | - Barbara Pizzi
- SS Filippo and Nicola Academic Hospital of Avezzano, Avezzano, Italy
| | - Rosaria Coletta
- SS Filippo and Nicola Academic Hospital of Avezzano, Avezzano, Italy
| | | | - Stefano Necozione
- Department of life health & environmental sciences, University of L'Aquila
| | - Pierfrancesco Fusco
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, Italy
| | - Franco Marinangeli
- Department of life health & environmental sciences, University of L'Aquila
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Atalay YO, Mursel E, Ciftci B, Iptec G. Clavipectoral Fascia Plane Block for Analgesia after Clavicle Surgery. Rev Esp Anestesiol Reanim (Engl Ed) 2019; 66:562-563. [PMID: 31727320 DOI: 10.1016/j.redar.2019.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Y O Atalay
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
| | - E Mursel
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - B Ciftci
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - G Iptec
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey
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Karakış A, Tapar H, Özsoy Z, Suren M, Dogru S, Karaman T, Karaman S, Sahin A, Kanadlı H. Perioperative analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy: a randomized controlled trial. Brazilian Journal of Anesthesiology (English Edition) 2019. [PMID: 31627901 PMCID: PMC9391879 DOI: 10.1016/j.bjane.2019.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alkan Karakış
- Kilis State Hospital, Department of Anesthesiology and Reanimation, Kilis, Turquia.
| | - Hakan Tapar
- Gaziosmanpasa University, Medical Faculty, Department of Anesthesiology and Reanimation, Tokat, Turquia
| | - Zeki Özsoy
- Gaziosmanpasa University, Medical Faculty, Department of General Surgery, Tokat, Turquia
| | - Mustafa Suren
- Gaziosmanpasa University, Medical Faculty, Department of Anesthesiology and Reanimation, Tokat, Turquia
| | - Serkan Dogru
- Gaziosmanpasa University, Medical Faculty, Department of Anesthesiology and Reanimation, Tokat, Turquia
| | - Tuğba Karaman
- Gaziosmanpasa University, Medical Faculty, Department of Anesthesiology and Reanimation, Tokat, Turquia
| | - Serkan Karaman
- Gaziosmanpasa University, Medical Faculty, Department of Anesthesiology and Reanimation, Tokat, Turquia
| | - Aynur Sahin
- Gaziosmanpasa University, Medical Faculty, Department of Anesthesiology and Reanimation, Tokat, Turquia
| | - Hasan Kanadlı
- Kilis State Hospital, Department of Anesthesiology and Reanimation, Kilis, Turquia
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Goulart TF, de Araujo-Filho VJF, Cernea CR, Matos LL. Superficial cervical plexus blockade improves pain control after thyroidectomy: A randomized controlled trial. Clinics (Sao Paulo) 2019; 74:e605. [PMID: 31531572 PMCID: PMC6735272 DOI: 10.6061/clinics/2019/e605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/24/2019] [Indexed: 11/29/2022] Open
Abstract
OJECTIVES The aim was to evaluate the ability of bilateral superficial cervical plexus blockade to control pain and to reduce the side effects of general anesthesia in patients submitted to thyroidectomy. METHODS In this randomized controlled trial, we prospectively studied 100 consecutive patients who underwent total thyroidectomy. The simple random patient sample was divided into two groups: 50 patients received general anesthesia alone (group 1 [G1]), and 50 patients received general anesthesia with bilateral superficial cervical plexus blockade (group 2 [G2]). Statistical analyses were performed, and a 5% significance level was adopted. RESULTS The mean arterial blood pressure and heart rate were 12% lower in G2 patients than in G1 patients 60 minutes after surgery (101 mmHg for G1 vs. 92.3 mmHg for G2; p<0.001). G2 patients reported less pain than G1 patients, and opioid consumption was lower in G2 patients than in G1 patients, not upon postanesthesia care unit arrival, but at 30 minutes (2% vs. 34%; p<0.001, respectively), 45 minutes (0% vs. 16%; p=0.006, respectively), and 4 hours postoperatively (6% vs. 20%; p=0.037, respectively). The incidence of nausea and vomiting was lower in G2 patients than in G1 patients from 45 minutes (0% vs. 16%; p=0.006, respectively) to 8 hours postoperatively (0% vs. 14%; p=0.012, respectively). CONCLUSIONS The present study demonstrated that the combination of bilateral superficial cervical plexus blockade with general anesthesia for thyroidectomy is feasible, safe, and effective for achieving pain control and improving patient outcomes.
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Affiliation(s)
- Taís Fonseca Goulart
- Departamento de Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding authors. E-mail:
| | - Vergilius José Furtado de Araujo-Filho
- Departamento de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding authors. E-mail:
| | - Claudio Roberto Cernea
- Departamento de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Leandro Luongo Matos
- Departamento de Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding authors. E-mail:
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Ho B, De Paoli M. Use of Ultrasound-Guided Superficial Cervical Plexus Block for Pain Management in the Emergency Department. J Emerg Med 2018; 55:87-95. [PMID: 29858144 DOI: 10.1016/j.jemermed.2018.04.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/09/2018] [Accepted: 04/11/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although use of the superficial cervical plexus block (SCPB) by anesthesia for perioperative indications is well described, there is a paucity of research on use of SCPB in the emergency department (ED). OBJECTIVE This prospective observational study aims to prospectively characterize the feasibility, potential for efficacy, and safety of ultrasound-guided SCPB in a convenience sample of ED patients presenting with painful conditions of the "cape" distribution of the neck and shoulder. METHODS Data were gathered prospectively on a convenience sample of 27 patients presenting to a community ED with painful conditions involving the distribution of the SCPB: para-cervical muscle spasm/pain (n = 8), clavicle fractures (n = 7), acromioclavicular joint injuries (n = 3), radicular pain (n = 3), and rotator cuff disorders (n = 6). Pre- and post-block 11-point verbal numeric pain scores (VNPS) were recorded, as was the incidence of any immediate complications. A retrospective chart review looked for delayed complications in the 14-day post-block period. RESULTS The mean 11-point VNPS reduction was 5.4 points (62%). There were no early serious complications and one case each of self-limiting vocal hoarseness and asymptomatic hemi-diaphragmatic paresis. No delayed block-related complications were found. CONCLUSIONS While limited by the fact that this was a nonrandomized observational experience with no control group, our findings suggest that SCBP may be safe and have potential for efficacy, and warrants further evaluation in a randomized controlled trial.
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Affiliation(s)
- Ben Ho
- Emergency Department, Nanaimo Regional General Hospital, Nanaimo, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Nanaimo, British Columbia, Canada
| | - Michael De Paoli
- Department of Family Medicine, University of British Columbia, Nanaimo, British Columbia, Canada
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Bombil I, Louw L, Mitchell C, Mahlobo F, Muganza RA, Madima NR. Sonar guided focused parathyroidectomy under cervical block. S AFR J SURG 2018; 56:30-33. [PMID: 30010261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Presentation of hyperparathyroidism varies and is highly non-specific. The automated calcium analyzer has made the diagnosis easy. Similarly, the advent of Sestamibi scan has paved the way to minimally invasive parathyroidectomy indicated for parathyroid adenoma. There is no uniformity in the extent of minimally invasive parathyroidectomy that is done through limited incision under radio or sonar guidance and endoscopically. In this study, we are presenting the focused parathyroidectomy performed under sonar guidance and superficial cervical block (SCB). The prerequisite is concordant preoperative Sestamibi and ultrasound imaging. METHOD A two-year review of parathyroidectomies performed between January 2013 and December 2014. OBJECTIVE To reflect on the result of sonar-guided focused parathyroidectomy under SCB. RESULTS There was good correlation between the pre-operative imaging, the intra-operative findings and the postoperative histology result of the 15 cases analysed. CONCLUSION The focused parathyroidectomy under SCB yielded a good result with concordant preoperative Sestamibi and ultrasound findings.
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Affiliation(s)
- I Bombil
- Department of Surgery, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
| | - L Louw
- Department of Nuclear Medicine, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
| | - C Mitchell
- Department of Surgery, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
| | - F Mahlobo
- Department of Radiology, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
| | - R A Muganza
- Department of Surgery, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
| | - N R Madima
- Department of Anesthesiology, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
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Shrestha BR, Sharma P. Regional Anaesthesia in Clavicle Surgery. JNMA J Nepal Med Assoc 2017; 56:265-267. [PMID: 28746327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
In routine practice, regional anaesthesia is less commonly used for clavicular fracture compared to general anaesthesia. We report two cases of clavicle fracture for which operative treatment was done under combined superficial cervical plexus and interscalene brachial plexus block. In both the cases combination of ropivacaine and dexmeditomidine was used for block. Both the patients exhibited comfort and there was no additional analgesic demand in both the cases. Thus combination of interscalene and superficial cervical plexus block can prove to be useful in patients with clavicle fracture where administration of general anaesthesia and its adverse effects could be avoided.
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Affiliation(s)
- B R Shrestha
- Department of Anaesthesiology and Intensive Care, Kathmandu Medical College, Nepal
| | - P Sharma
- Department of Anaesthesiology and Intensive Care, Kathmandu Medical College, Nepal
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Wang H, Ma L, Yang D, Wang T, Wang Q, Zhang L, Ding W. Cervical plexus anesthesia versus general anesthesia for anterior cervical discectomy and fusion surgery: A randomized clinical trial. Medicine (Baltimore) 2017; 96:e6119. [PMID: 28207536 PMCID: PMC5319525 DOI: 10.1097/md.0000000000006119] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Both general anesthesia (GA) and cervical plexus anesthesia (CPA) can be used for anterior cervical discectomy and fusion (ACDF) surgery. The aim of this study was to evaluate the influence of anesthetic techniques on perioperative mortality and morbidity in patients undergoing cervical surgery.From January 2008 to December 2015, 356 patients who underwent 1-level ACDF for cervical spinal myelopathy were prospectively reviewed. They were assigned to receive GA (group A) and CPA (group B). The analgesic efficacy of the block was assessed by anesthesia preparation time, the maximum heart rate, and mean arterial blood pressure changes compared with the baseline, time of postoperative revival, and duration of recovery stay. Duration of surgery, blood loss, and anesthesia medical cost were also recorded. Numerical rating scale (NRS) was used to evaluate pain at different time points. Postoperative nausea and vomiting (PONV) was assessed, and postoperative average administered dosages of meperidine and metoclopramide were also recorded. The spinal surgeon satisfaction, anesthetist satisfaction, and patient satisfaction were assessed.Both the anesthesia induction time and postoperative revival time were longer in group A than that in group B; both the duration of surgery and recovery stay were also longer in group A than that in group B, whereas there was no difference in blood loss between the 2 groups. The average dosage of both meperidine and metoclopramide was more in group A than that in group B, and the anesthesia medical cost was greater in group A than that in group B. There were no significant differences in baseline data of systolic blood pressure, diastolic blood pressure, and heart rate between the 2 groups. But the intraoperative data of systolic blood pressure, diastolic blood pressure, and heart rate were higher/larger in group B than that in group A. In group A, there was no complaint of pain in the surgery procedure, but the pain increased after GA, with highest degree at 8 hours postoperation; then the pain degree decreased, and the NRS was 1 at 24 hours postoperation. In group B, intraoperative pain was NRS 4, and pain degree decreased from 4 hours postoperation; the NRS was 2 at 24 hours postoperation. The incidence of severe PONV was higher in group A than that in group B. There was no significant difference in the spinal surgeon satisfaction and anesthetist satisfaction for the anesthetic techniques. There was significant difference in patient satisfaction between the 2 groups, with high satisfaction for GA.General anesthesia is superior to CPA in maintaining better intraoperative hemodynamic stability and providing high patient satisfaction with no intraoperative pain for patients receiving ACDF, but it entails longer surgery and anesthesia time, and requires more postoperative analgesic and anesthesia cost.
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Affiliation(s)
| | - Lei Ma
- Department of Spine Surgery
| | | | | | - Qian Wang
- Financial Statistics Office, The Third Hospital of HeBei Medical University
| | - Lijun Zhang
- The Orthopaedic Department From First Hospital of Shijiazhuang, Shijiazhuang, China
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Heller B, Levine A. BILATERAL SUPERFICIAL CERVICAL BLOCKS AS THE PRIMARY ANESTHETIC FOR THE PATIENT UNDERGOING AN EVACUATION OF NECK HEMATOMA AFTER PARATHYROID SURGERY. Middle East J Anaesthesiol 2015; 23:363-366. [PMID: 26860031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This is the case of an 80-year-old female who presented for evacuation of a neck hematoma on POD#3 after a parathyroidectomy. Her medical history included coronary artery disease with a drug-eluding stent, off aspirin for 2 weeks. She had a significant hematoma from the hyoid bone extending down to below the suprasternal notch. She reported hoarseness. The anesthesiology team provided regional anesthesia with bilateral superficial cervical blocks, supplemented with minimal sedation for patient compliance. The surgical team used no adjuvant local anesthetic. A deep exploration was performed and significant clot was evacuated. The patient went home safely from the PACU.
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Barone M, Brigand C, Sonnek T, Ramlugun D, Calon B, Rottenberg D, Diemunsch P. Intermediate cervical plexus block for cervical esophagus diverticulectomy. Acta Anaesthesiol Belg 2015; 66:59-61. [PMID: 26455010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report the case of a 97 year old woman suffering from a voluminous diverticle of the cervical esophagus with important comorbidities and a very poor quality of life. A diverticulectomy under general anesthesia implied a high level of risk. Regional anesthesia was chosen, i.e. an intermediate cervical plexus block, with mild sedation allowing to maintain contact with the patient. The procedure was carried out without complications and the patient's and surgical staff satisfaction were optimal.
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