THE ANALGESIC EFFICACY OF BILATERAL BLOCKADE OF SUPERFICIAL CERVICAL PLEXUS UNDER SEVOFLURANE GENERAL ANESTHESIA IN THYROIDECTOMY PATIENTS
Keywords:
anesthesiological management, thyrotoxicosis, thyroidectomy, balanced (multimodal) anesthesia, analgesic and anaesthetic consumption, postoperative nausea and vomitingAbstract
Aim: To evaluate the analgesic component of the bilateral blockade of superficial cervical plexus under sevoflurane general anesthetic in a complex of anesthetic management of thyrotoxicosis patients undergoing thyroidectomy in a specialized centre of endocrine surgery. Materils and methods. All patients were divided into 2 groups: a group of “balanced analgesia — sevoflurane” (BA-S) — 44 patients, a group of “control-sevoflurane ‘(C-S) was 46 patients. All thyrotoxicosis patients were performed thyroidectomy under general anesthesia with mechanical ventilation in and using of the lowflow anesthesia (LFA) or the minimal flow anesthesia (MFA) by sevoflurane. In the groups BA-S was used MFA with the fresh gas flow (FGF)=400 ml/min, in the group C-S was used LFA with FGF=500 ml/min. In the group of BA-S before the sevoflurane general anesthesia was performed the bilateral blockade of superficial cervical plexus (BBSCP) as a component of a balanced (multimodal) analgesia (BMMA) of anesthetic management. There estimated the sevoflurane consumption. Pain level was assessed by VAS, the use of narcotic and non-narcotic analgesics, the frequency and severity of PONV during the first 24 hours of postoperative (post-op) period. Results and discussion. The combination of the BBSCP with sevoflurane anesthesia reduces of an opioid requirement and opioid consumption in the intra-and postoperative periods. The groups BA-S was not necessity to use of narcotic analgesics in the post-op period unlike groups C-S, where narcotic analgesics were used in 94.9 % patients. Because the BBSCP provides the high efficiency of post-op analgesia for a long time. According to VAS the level of pain in the groups BA-S and was evaluated as a weak pain and was significantly (p<0.05) lower compare to the groups C-S. Application BMMA previously of the sevoflurane basic anesthesia in BA-S group provides intraoperative opioid-sparing effect: a significant (p<0.05) decrease in intraoperative fentanyl consumption to 283.4±12.4 mcg per transaction compared with the group of K-C (376.9±12,9 mcg). BMMA complex will significantly (p<0.05) increase the level of patients without PONV to 72.7 % in the group BA-S (in C-S this mark was 45.7 %). Total score on the scale of PONV was significantly lower in the SA-C group (0.41±0.11). The sevoflurane consumption was significantly (p<0.05) lower by Wilcoxon test in the BA-S group, where used FGF=400 ml/min, comparing to the control group C-S. Cost-effective analysis has shown the benefits of using MFA, which was applied in the BA-S group and amounted to 143.8± ±5,9 UAH and 164.5±6,6 UAH as for both equations, Dion and the vaporizer weighing, respectively. Conclusions. The introduction of the BMMA complex into anesthetic management of patients with thyrotoxicosis, who undergoing the thyroidectomy, in the form of bilateral blockade of superficial cervical plexus by 0.5 % bupivacaine solution with the addition of IV dexamethasone 4–8 mg and IV 50 mg dexketoprofen before induction of anesthesia has provided a high level of analgesia in post-op period in the sevoflurane inhalation anesthesia group; has provided opioid-sparing effect in post-op period of due to lack of demand in the use of narcotic analgesics; has reduced post-operative pain and the frequency and severity of PONV, NSAIDs consumption. The sevoflurane consumption was significantly (p<0,05) lower under MFA with FGF=400 ml/min, compared with LFA with FGF=500ml/min. Costeffective analysis has shown the benefits of using MFA vs LFA.
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