A Comparative Study on Analgesic efficacy of Bilateral Superficial Cervical Plexus Block with 0.25% Bupivacaine and 0.25% Bupivacaine with Clonidine for Thyroidectomy Surgeries

Nimisha, Checha Jacob (2011) A Comparative Study on Analgesic efficacy of Bilateral Superficial Cervical Plexus Block with 0.25% Bupivacaine and 0.25% Bupivacaine with Clonidine for Thyroidectomy Surgeries. Masters thesis, Chengalpattu Medical College, Chengalpattu.


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INTRODUCTION: Pain is a protective mechanism designed to alert the body to potentially injurious stimuli. The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Alleviation of pain has been the focus of continuing human effort over centuries. Thyroid operations can cause mild to moderate incisional pain. In addition, discomfort in swallowing, burning sensation in the throat, nausea, and vomiting can be caused by the operation or by general anaesthesia. These affect a majority of the patients, especially within the first day after operation. Surgeons and anaesthesiologists have attempted to prevent or treat these problems with various modalities, such as opioids and nonsteroidal antiinflammatory drugs, or with additional locoregional anaesthesia techniques. Locoregional anaesthesia, such as local anaesthetic wound infiltration, bilateral superficial cervical plexus block (BSCPB), and bilateral combined superficial and deep cervical plexus block, can potentially reduce postoperative pain in patients who undergo thyroidectomy. Bilateral superficial cervical plexus block (BSCPB) is a popular regional anaesthesia technique for its feasibility and efficacy. Clonidine, an alpha-2 adrenergic agonist, has been used as an adjuvant to local anaesthetics in various regional techniques to extend the duration of block. This study was conducted to see the efficacy of Clonidine as an adjunct to Bupivacaine in post operative pain relief following bilateral superficial cervical plexus block for thyroid surgeries. All patients undergoing thyroidectomy surgeries under general anaesthesia, received bilateral superficial cervical plexus block using 6ml of 0.25% Bupivacaine (Group B) or 6ml of 0.25% Bupivacaine with Clonidine 5 μg/ml (Group C) on each side. AIM OF THE STUDY: To evaluate the quality and duration of postoperative analgesia with bilateral superficial cervical plexus block for patients undergoing thyroidectomy surgeries under general anaesthesia using 0.25% Bupivacaine (Group B) and 0.25% Bupivacaine with Clonidine 5 μg/ml (Group C). MATERIALS AND METHODS: Study Design And Equipment: This was a Prospective Randomized Double Blind study conducted in 40 adult patients undergoing thyroidectomy surgeries from August 2009 to September 2010 under General Anaesthesia at Chengalpattu Medical College Hospital, Chengalpattu. The study was done with Ethical Committee approval and written informed consent obtained from all patients included in the study. An Anaesthesiology Consultant who did not take any part in the study drew the group B or group C drug in a syringe and coded them and was handed over to an Anaesthesiology resident who performed the block. Another resident was asked to conduct the anaesthesia and also take down the data as per the proforma attached. Selection of Cases: Inclusion Criteria: 1. ASA grade I & II patients of either sex, 2. Age 20 – 60 yrs, 3. Euthyroid patients, 4. Type of surgery: Thyroidectomy. Exclusion criteria: 1. Substernal goiters, 2. Thyroidectomy with lymph node dissection, 3. Inability to use the pain scale, 4. Coagulation disorders. METHOD: 40 patients under ASA I and II scheduled to undergo elective thyroidectomy surgery were included in this study. Patients included in the study underwent thorough preoperative evaluation which included detailed history, physical examination, investigations (Hemoglobin, PCV, Blood Urea, Serum Creatinine, Serum Electrolytes, Random blood sugar, Thyroid Function Test, Urine albumin-sugar, ECG, Chest X Ray, X Ray Neck) and Indirect Laryngoscopy. The patients were randomly allocated into two groups – Group B and Group C. All the patients were premedicated with oral ranitidine 150mg two hours before surgery with a sip of water. Anaesthesia machine, drug trolley including emergency drugs and difficult airway tray were checked. Patients were monitored with Non invasive blood pressure monitoring, Pulse oximeter, five lead ECG and temperature. STATISTICAL ANALYSIS: All collected data were entered into computer using MS Excel software and analysed using STATA software. Descriptive analysis presented in the form of Tables and Graphs. The level of significance was 0.05 used for determining the significance of different variables. Student ‘t’ test was used to determine the significance of quantitative variables (heart rate, systolic, diastolic and mean arterial pressure). Chi-square exact test was used to test the significance of qualitative data (pain and sedation score). CONCLUSION: Thyroidectomy is routinely done under general anaesthesia supplemented with postoperative narcotics in our institution. Thyroidectomy done under general anaesthesia and bilateral superficial cervical plexus block gives better patient comfort in the postoperative period. The addition of alpha-2 adrenergic agonist Clonidine as an adjuvant to local anaesthetic has improved and prolonged postoperative analgesia and mild sedation without any significant adverse effects. There is lesser consumption of postoperative narcotics and it also facilitates a smooth transition from intraoperative to postoperative period.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Analgesic efficacy ; Bilateral Superficial Cervical Plexus Block ; 0.25% Bupivacaine ; 0.25% Bupivacaine ; Clonidine ; Thyroidectomy Surgeries ; Comparative study.
Subjects: MEDICAL > Anaesthesiology
Depositing User: Subramani R
Date Deposited: 30 Apr 2018 04:14
Last Modified: 30 Apr 2018 04:14
URI: http://repository-tnmgrmu.ac.in/id/eprint/7356

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