Analgesic efficacy of bilateral superficial and deep cervical plexus block in patients with secondary hyperparathyroidism due to chronic renal failure

Abstract

PurposeSecondary hyperparathyroidism (SHPT) develops in patients with chronic renal failure. This study aimed to compare analgesic efficacy in SHPT patients who undergo subtotal parathyroidectomy after superficial versus deep cervical plexus block.MethodsSixty chronic renal failure patients with SPHT scheduled for subtotal parathyroidectomy were randomized to receive general anesthesia (group GA), general anesthesia plus bilateral superficial and deep cervical plexus block (group BD), or general anesthesia plus bilateral superficial cervical plexus block (group BS) (n = 20). Bilateral superficial cervical plexus block or combined superficial and deep cervical plexus block with 0.5% ropivacaine was administered. Postoperative pain was assessed using visual analogue scale (VAS).ResultsVAS score at 1 hour, 4 hours, and 8 hours after operation was 3.71 ± 0.60, 2.72 ± 0.54, 2.17 ± 0.75 in BS group; 4.00 ± 0.28, 2.89 ± 0.21, and 2.46 ± 1.01 in BD group, significantly lower than in GA group (6.50 ± 0.50, 5.02 ± 0.54, and 4.86 ± 0.51, respectively). The dosage of tramadol was 109.0 ± 35.2 mg in BS group and 93.0 ± 24.52 mg in BD group, significantly lower than in GA group (300.0 ± 27.13 mg). The incidence of complications in GA group (90%) was significantly higher than in BS group (30%) and BD group (15%). Serum glucose and norepinephrine levels were significantly higher at 1 hour, 4 hours, and 8 hours after operation, but returned to baseline levels at 24 hours after operation.ConclusionSuperficial cervical plexus block or combined superficial and deep cervical plexus block effectively reduces postoperative pain, stress response, and complications in SHPT patients who undergo subtotal parathyroidectomy.

Ultrasound-guided bilateral superficial cervical plexus block enhances the quality of recovery of uremia patients with secondary hyperparathyroidism following parathyroidectomy: a randomized controlled trial

“…If parathyroid hormone levels are persistently elevated >800 pg/ml (>6 months) and pharmacological therapy remains ineffective, uremia patients with SHPT may undergo parathyroidectomy [ 4 ]. For total or subtotal parathyroidectomy, the surgical stimulus during gland dissection is mostly gentle, local or regional anesthesia is sufficient, and both types of anesthesia can provide postoperative analgesia [ 5 – 7 ]. However, the conventional anesthetic technique for parathyroidectomy is total intravenous anesthesia with tracheal intubation and muscle relaxation [ 8 ].…”

Perioperative analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy: a randomized controlled trial

“…Inadequate postoperative pain control increases the level of stress hormones and the rate of perioperative complications. 3 General anesthesia alone is often insufficient as a postoperative analgesia; most patients require additional doses. 4 …”

Analgesic efficacy of ropivacaine wound infusion after laparoscopic colorectal surgery

“…Postoperative pain is one of the major concerns of surgical patients. It may contribute to a variety of complications and delay recovery after surgery [ 1 2 3 ]. Various analgesic modalities have been used to reduce postoperative pain, however pain control remains a challenging area for most surgeons and anesthesiologists [ 2 4 ].…”