الفهرس 
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Abstract
Anesthesia for thyroid surgery may appear quite simple as surgical stimulation during dissection of the gland is gentle in uncomplicated cases to the degree that being successfully performed under regional anesthesia or hypnosis only. In contrast; when general anesthesia is used for thyroid surgery, it is relatively a deep one. This is probably related to the combination of surgery and frequent tracheal stimulation associated with movement of endotracheal tube during surgical manipulation. Deep anesthesia may delay recovery, so the use of short acting opioids appears to be a favorite choice, but postoperative hyperalgesia is a major disadvantage.
Although thyroid surgery is a short-stay procedure, most patients require effective postoperative analgesia. It has been reported that the mean postoperative pain score was 6.9 on a visual analog scale (VAS) from 0 to 10 and 90% of the patients required morphine during the first postoperative day. However, nausea and vomiting are the most frequent side effects of opioids. Therefore the most recent studies concerning post-thyroidectomy analgesia are focused on the efficacy of regional techniques to reduce postoperative opioid requirements.
This randomized controlled clinical trial took place at Suez Canal University Hospital in the routine surgical theatres and surgical inward to assess intraoperative and postoperative analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy under general anesthesia where 46 American Society of Anesthesiologists’ physical statuses I, and II patients undergoing total and partial thyroidectomy were randomly allocated to one of two equal groups on alternative basis as following:
Group (C): (23 patients) received general anesthesia
Group (B): (23 patients) received general anesthesia and bilateral superficial cervical plexus block with 10 mL Bupivacaine 0.5% for each side.
All patients received general anesthesia where induction started with 2 mg/kg propofol and 2 μg/kg fentanyl. Neuromuscular block was established with 0.15 mg/kg cis-atracurium. The baseline arterial blood pressure and heart rate were obtained. Rescue analgesia of 0.5 μg/kg fentanyl was given when the heart rate or the systolic arterial blood pressure increase more than 20% compared with the baseline value. Before skin incision superficial cervical plexus block was performed in group (B) patients only using 0.5% Bupivacaine. Intravenous Patient-Controlled morphine Analgesia was commenced on admission to the PACU in all groups.
Intraoperative analgesia was estimated through haemodynamic stability and extra fentanyl consumption. Postoperative analgesia was estimated through VAS score, total morphine consumption 24 hours post-operative through PCA and 1st analgesic request rescue analgesia.
The statistical analysis was performed using a Statistical Package for the Social Sciences SPSS® version 15 for windows operating system.
Results showed that haemodynamics where more stable with the block group all over the operation time. Also, there was no extra fentanyl consumption in the block group in contrast to the control group where four patients needed extra analgesia intraoperatively.
Also, there was high statistically significant difference between both groups regarding post-operative VAS values with being higher in the control group.
As for postoperative total morphin consumption, there was high statistically significant difference between both groups. Also there was high statistically significant difference between both groups regarding the 1st analgesic request.
Results showed that there was no statistically significant difference in incidence of post-operative nausea and vomiting between both groups.
After systematic bibliographic research, we found a few articles with controversial results evaluating the value of BSCPB when employed for thyroid surgery.
In conclusion, the present randomized controlled study demonstrated that bilateral superficial cervical plexus block with 0.5% bupivacaine has a major analgesic effect on patients undergoing thyroidectomy.
BSCPB is a safe and easy technique that reduces intaoperative and postoperative opioid consumption and also reduces postoperative pain.
Finally, we recommend the Routine use of bilateral superficial cervical plexus block in patients undergoing thyroidectomy to reduce perioperative total opioid consumption and postoperative pain. Also, further trials should be done to evaluate a dose-response relationship, effect of possible adjuvant agents, its efficacy in comparison to an image-guided technique and the possibility to use it alone for thyroid surgeries anesthesia.