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Orthopädie 6. August 2015

Bilateral superficial cervical plexus block combined with bilateral greater occipital nerve block reduces the impact of different sources of pain after thyroid surgery with less consumption of morphine-PCA: a randomized trial

Background: Our aim was to demonstrate the analgesic efficacy of the bilateral superficial cervical plexus block (BSCPB) combined with bilateral greater occipital nerve block (BGONB) on different sources of pain after thyroid surgery; in terms of pain scores and morphine-PCA consumption in the first 24 h.

Materials and method: Sixty patients were randomized into three groups; Group C (n = 20) to receive management without blocks; Group GS (n = 20), the combination of BSCPB and BGONB; and Group S (n = 20), BSCPB alone. Levobupivacaine of 0.25 % (15 ml (each side) for BSCPB; 5 ml (each side) BGONB) was used for nerve blocks. All patients received morphine-PCA for the first 24 h postoperatively. In all, 0 h, 1 h, 2 h, 4 h, 6 h, 12 h, and 24 h were the measurement times for incision pain at rest, pain on swallowing, headache, and posterior neck pain scores (VAS) and PONV. Requirement for rescue analgesics and 24 h morphine consumption were recorded.

Results: Incision pain scores at rest and on swallowing was lower in Groups GS and S (p  < 0.001). Posterior neck pain scores were lower in Group GS (p  < 0.001). Headache was similar in all groups, but the number of patients with pain scores VAS > 3 was lower in Group GS (p < 0.001). In Groups GS and S 24 h morphine consumption was lower, compared to Group C (p  < 0.001). PONV and rescue analgesic use were similar.

Conclusion: The combination of three-injection technique BSCPB with BGONB performed before surgical incision by using 0.25 % levobupivacaine, significantly reduced incision pain at rest, incision pain on swallowing, headache and posterior neck pain after thyroid surgery, while reducing morphine consumption in 24 h postoperatively.

F. Kılınçkan, F. Uzumcugil, M. Sayın, O. Ozlu, O. Bayir, European Surgery 4/2015

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