PurposeThyroidectomy causes postoperative pain and patient discomfort. Bilateral superficial cervical plexus block is a regional anesthesia technique that can provide analgesia during and after surgery. This study aims to compare the effectiveness of ultrasound (US)-guided versus landmark (LM) technique for bilateral superficial cervical plexus block in thyroidectomy.Patients and methodsThirty-six patients undergoing thyroidectomy were divided into two groups randomly (n=18); either US-guided (US group) or LM technique (LM group) for bilateral superficial cervical plexus block. Patient-controlled analgesia was used to control postoperative pain. Intraoperative opioid rescue, postoperative visual analog scale (VAS) score and opioid consumption were measured.ResultsThe number of patients who required intraoperative opioid rescue was significantly lower in the US group (p≤0.05). There was no significant difference in postoperative VAS score at 3 hours (p>0.05), but postoperative VAS score at 6 and 24 hours was significantly lower in the US group (p≤0.05). Twenty-four hour postoperative opioid consumption was significantly lower in the US group (p≤0.05).ConclusionUltrasound-guided bilateral superficial cervical plexus block is more effective in reducing pain both intra- and postoperatively compared with landmark technique in patients undergoing thyroidectomy.

COMPARATIVE ANALGESIC EFFECTS OF AMITRIPTYLINE, GABAPENTIN, AND PREGABALIN IN DIABETIC NEUROPATHY AND TRIGEMINAL NEURALGIAABSTRACTIntroduction: The management of neuropathic pain is a challenge for clinicians because of its nonspecific and difficult clinical to treat characteristics. The e use of antidepressant drugs such as amitriptyline and anticonvulsants such as gabapentin and pregabalin has shown various efficacy overcoming neuropathic pain.Aim: To compare the analgesic  efficacy of amitriptyline, gabapentin, and pregabalin  in patients with diabetic neuropathy and trigeminal neuralgia.Methods: This is an experimental pre and post test study on patients with diabetic neuropathy and trigeminal neuralgia in neurology clinic Haji Adam Malik Hospital, Medan, from April 2015 to march 2017. in each disease, subjects were divided into three groups, each was treated either with oral amitriptyline 12.5mg, gabapentin 100mg, or pregabalin 75mg twice daily. The Numeric Rating Scale to assess pain intensity were examined before and after two weeks after treatment.Results: The number of diabetic neuropathy subjects was 75, while trigeminal neuralgia subjects was 30, each were divided into three groups treated either with amitriptyline, gabapentin, or pregabalin. There were no differences on pain intensity changes in diabetic neuropathy groups but significant differences were shown in trigeminal neuralgia groups.Discussion: Amitriptyline, gabapentin, and pregabalin effective to lower pain intensity in trigeminal neuralgia significantly compare to diabetic neuropathy.Keywords: Amitriptyline, diabetic neuropathy, gabaptentin, pregabalin, trigeminal neuralgiaABSTRAKPendahuluan: Pengelolaan nyeri neuropatik merupakan tantangan bagi klinisi karena karakteristik klinisnya yang nonspesifik dan tatalaksananya yang sulit. Penggunaan antidepresan seperti amitriptilin dan antikonvulsan seperti gabapentin dan pregabalin mempunyai efikasi yang berbeda-beda dalam mengatasi nyeri neuropatik.Tujuan: Mengetahui perbedaan efek analgesik dari amitriptilin, gabapentin, dan pregabalin pada penderita neuropati diabetik dan neuralgia trigeminal.Metode: Studi eksperimental pre dan post test terhadap pasien neuropati diabetik atau neuralgia trigeminal yang berobat ke Poliklinik Neurologi RSUP Haji Adam Malik, Medan, sejak bulan April 2015 hingga Maret 2017. Semua subjek dibagi menjadi tiga kelompok untuk setiap penyakit, yang masing-masing mendapatkan amitriptilin 12,5mg, gabapentin 100mg, dan pregabalin 75mg, dengan frekuensi pemberian obat dua kali sehari setiap kelompok. Pengukuran intensitas nyeri dengan menggunakan Numeric rating Scale dilakukan sebelum dan setelah dua minggu pengobatan.Hasil: Didapatkan subjek dengan neuropati diabetik sebanyak 75 orang dan neuralgia trigeminal 30 orang yang masing-masing dibagi menjadi 3 kelompok dengan terapi amitriptilin, gabapentin, dan pregabalin. Tidak terdapat perbedaan rerata perubahan intensitas nyeri yang bermakna pada kelompok neuropati diabetik, namun bermakna pada subjek neuralgia trigeminal.Diskusi: Amitriptilin, gabapentin, dan pregabalin memiliki efikasi dalam menurunkan intensitas nyeri pada neuralgia trigeminal secara bermakna dibandingkan pada neuropati diabetik.Kata kunci: Amitriptilin, gabapentin, neuralgia trigeminal, neuropati diabetik,pregabalin