الفهرس 
Physiology of Pain and its ManagementOnly 14 pages are availabe for public view
 |  | from | 114 |  |  |
| | | from | 114 | | |
Abstract
Globally, thyroid diseases are becoming more prevalent. The primary suggested course of treatment is either a partial or complete thyroidectomy. Thyroidectomy patients still endure pain (including incision site pain, posterior neck pain, and occipital headache), discomfort, and postoperative nausea & vomiting (PONV) despite the procedure taking only a short while.
An essential component of perioperative care is postoperative analgesia. An effective analgesic after surgery can enhance the surgical outcome. Opioids, non-steroidal anti-inflammatory medications (NSAIDs), local anesthetic, or regional anesthesia are among the major modalities used to treat surgical pain.
Opioids used in the ward can have several negative side effects that are detrimental to recovery after thyroid surgery, including sleepiness, respiratory depression, nausea, and vomiting (which can cause dislodgement of the sutures in the neck).
In this context, regional blocks are being employed more frequently, with excellent results. Thyroidectomy patients frequently undergo bilateral superficial cervical plexus block (BSCPB), a common regional anesthetic. Numerous research investigations have indicated that BSCPB enhances intraoperative pain management, minimizes the quantity of general anesthetic medications needed for thyroidectomy, and lessens the intensity of postoperative pain. Both the traditional landmark (LM) approach and ultrasound guidance can help with this surgery, but US guidance offers real-time visualization of anatomical features and needle movement, which lowers the risk of numerous problems.
Dexmedetomidine is an adrenergic receptor (AR) agonist specifically activates the alpha-2 adrenoreceptor. It is used as a sedative,
Summary
65
analgesic, and anti-anxiety drug. Furthermore, research has demonstrated
that local administration of dexmedetomidine, as a nerve-blocking
anesthetic, can stabilize hemodynamics, increase the duration of the nerve
block and enhance the analgesic impact following the surgery.
In the current study, we block the superficial cervical plexus under
guidance of ultrasound with bupivacaine and two doses (50 and 100 μg) of
dexmedetomidine, comparing the effects on postoperative analgesia.
To elucidate our aim, this study was double blinded randomized
prospective study conducted on 75 healthy adults aged ≥ 21 to ≤ 70 years
old with the American Society of Anesthesiology Physical Status (ASA) I,
II of both sex who scheduled for thyroidectomy under general anesthesia
attended to Menoufia university hospital from May 2020 to December
2022.
Measurements:
Pre-induction: Mean arterial blood pressure (MAP), heart rate (HR) and
arterial oxygen saturation (SaO2).
Intra-operative: Hemodynamics (MAP, HR) were assessed.
Postoperative: Post-operative pain was assessed using visual analogue
pain scale (VAS): every 0.5 hour after discharge from the post-anesthetic
care unit (PACU) for the following two hours, every 2 hours for next 6
hours, every 6 hours for remaining 24 hours post-operatively. Time to first
rescue analgesia and total postoperative consumption of analgesia
(morphine) in the first 24 hours was recorded. Follow up of the MBP&HR
(1, 2, 4, 8, 16, and 24) hours postoperatively. Incidence of complications
as hypotention, bradycardia and PONV was recorded. Patients’ satisfaction
with analgesia was evaluated every 12 hours after the operation based on a
5-point Likert scale.
Summary
66
The results of this study could be summarized as follow:
• There was no statistically significant difference among the studied groups regarding age, sex and ASA (P>0.05).
• Intra operative mean arterial blood pressure at 30, 45, 60, 75, 90, 105 and 120m was statistically significantly lower in group BD100 and BD50 than group B, with a significant difference between BD50 and BD100 groups.
• Intraoperative heart rate measurements at 60, 75, 90, 105, and 120 minutes were considerably lower in groups BD100 and BD50 than in group B, with a statistically significant difference between the former groups.
• Post-operative mean arterial blood pressure on PACU arrival, at 15, 30, 1h, 1.5h, 2h, 4h, 6h, 12h, 8h and 24h were statistically significant lower among group BD100 than group BD50 and group B.
• Post-operative heart rate on PACU arrival, after 15m, 30m, 1h, 1.5h, 2h, 4h, 6h, 12h, 8h and 24h were statistically significant lower among group BD100 than group BD50 and group B .
• Postoperative VAS was considerably lower in group BD100 than in groups BD50 and B after 30 minutes, 1 hour, 1.5 hours, 2 hours, 4 hours, 6 hours, 12 hours, 8 hours, and 24 hours.
• Mean time of 1st rescue analgesic was much longer in group BD100 than in group BD50 and group B, with a statistically significant difference. Furthermore, compared to group B, the BD100 and BD50 groups required less total postoperative morphine. Additionally, the BD100 group’s postoperative morphine demand was less than that of the BD50 group.
• Patient satisfaction after 12hr and 24hr was significantly increased among group BD100 and group BD50 than group B.
• Compared to groups BD50 and B, group BD100 show a higher frequency of controllable adverse effects.