Thyroid Surgery Clinical Trial
Official title:
The Efficacy of Intermediate Cervical Plexus Block Versus Cutaneous and Thyroid Capsular Blocks in Thyroid Surgeries
Thyroid gland surgery is one of the most commonly performed operations for either benign or malignant pathologies Pain related to thyroid surgery is of moderate intensity .which may be treated with NSAIDs or opioids. However, Opioids have many well-known undesirable effects, including postoperative nausea and vomiting, which are frequent after this type of procedure.
Regional techniques of anesthesia may help to decrease post-operative pain and reduce
systemic analgesic requirement. Classically, the cervical plexus is considered to have two
distributions, the superficial cutaneous and the deep motor nerves.
Anatomically, the thyroid gland has an inner true capsule which is thin and adheres closely
to the thyroidal tissue [Fancy et al., 2010]. External to this is a false capsule formed by
the middle layer of the deep cervical fascia, which splits anterolaterally to ensheathe the
thyroid gland, thus forming the thyroid sheath [Bliss et al., 2000]. In this fashion, the
potential space called the capsule-sheath space is formed. It contains also loose connective
tissue, blood vessels, nerves and parathyroid gland. Anesthetic deposited in this space would
block the surface of thyroid gland and permeate directly into the parenchyma producing
effective local anesthesia for thyroid surgical procedures. It is supposed also to involve
autonomic nerve block of the thyroid gland [Fliers et al., 2010]. Additionally, a
subcutaneous injection along the sternocleidomastoid muscle (SCM) would also enhance
effective local anesthesia for the initial skin incision and further contribute to a more
ideal working environment for the surgeon. Therefore, anesthetic technique termed
ultrasound-guided capsule-sheath space block (CSSB) combined with anterior cervical cutaneous
nerves block (CCNB) for thyroidectomy is done [Wang et al., 2015] .
Our hypothesis is that a combination of simple dual techniques including superficial
cutaneous block to provide sensory blockade, and surgeon mediated capsular block may afford
autonomic thyroid blockade. In comparison, ultrasound guided intermediate cervical plexus
block may provide these blocks but using a machine and deep penetration possibly involving
unwanted blocks for phrenic and recurrent laryngeal nerves. So, if the simple safe technique
can provide the same intra and postoperative anesthetic conditions it will be preferred.
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