Comparison of three different formulations of local anaesthetics for cervical epidural anaesthesia during thyroid surgery

Abstract

Background:To compare the efficacy and safety of local anaesthetics under cervical epidural anaesthesia (CEA) using lignocaine (1%), bupivacaine (0.25%) and ropivacaine (0.5%) for thyroid surgery.Methods:In a prospective, randomized fashion, 81 patients were selected for thyroid surgery under CEA. They were assigned to one of three groups: Group L, B and R to receive 10 mL of 1% lignocaine, 0.25% bupivacaine and 0.5% ropivacaine, respectively. We compared their efficacy in terms of pulmonary and haemodynamic parameters, blockade quality and complications.Results:Of the total, 74 patients completed the study successfully. Sensory block attained the median dermatomal range of C2-T4/T5 in all the groups. Motor block was more pronounced in the ropivacaine group. Cardiorespiratory parameters decreased significantly in all the groups; however, none of the patients had any major complications except for bradycardia in two patients. Among the measured variables, the decrease in heart rate and peak expiratory force was more in the lignocaine group while forced vital capacity and forced expiratory volume at 1 sec declined to a greater extent in the ropivacaine group. The lignocaine group required significantly more epidural top-ups compared with the other two groups.Conclusion:We conclude that cervical epidural route can be safely used for surgery on thyroid gland in patients with normal cardiorespiratory reserve, using either of local anaesthetics chosen for our study. Under the selected dose and concentrations, the decrease in cardiorespiratory parameters was lesser with bupivacaine.

Cervical epidural analgesia in current anaesthesia practice: systematic review of its clinical utility and rationale, and technical considerations

“…A majority-72% (51/73), were either single case reports or case series. Among the comparative studies, five were RCTs, [55][56][57][58][59] with the rest (n=17) being either prospective or retrospective OCTs. 3 60-75 The outcome details and study characteristics for all the RCTs are provided in Table 1.…”

“…55 66 68 Among CRs, CEA was attempted as the sole anaesthetic in 36 /51 reports. However, the following four studies reported conversion to GA for various reasons: a tired patient was induced GA after two h; 8 two out of three cases required nitrous oxide (N 2 O) support, out of which one was cancelled because of decreasing consciousness; 26 one patient was intubated because of respiratory difficulty; 28 three patchy epidurals were converted to GA. 57…”

“…Three reports used epidural nerve stimulation to identify and introduce the catheter. 5 12 14 Complications Dural punctures were reported in three reports [(n=1/50), 10 (n=2/ 394), 25 and (6.7% in group 2) 74 ]; respiratory difficulties to complete paralysis were reported in four reports [(n=1/7), 15 (n=1/15), 18 (n=3/394), 25 and (n=1) 28 ]; neurological complications were reported in four reports [( paraesthesia of the arm), 7 (right hemiparesis and Babinski sign), 11 (crus spasm and burning arm pain), 15 and (seizure) 26 ]; technical failures were reported in four reports [(n=1), 9 (n=1/3), 26 (n=1/50), 35 and (20% blocks at C4-5 were reported 57 ]; and serious haemodynamic and cardiac complications were reported in five reports. 22 25 31 33 46 There were no deaths reported; however, significant long-term morbidity and cardiac arrest were reported.…”

Cervical Epidural Anesthesia for Thyroidectomy in a Patient with a Potential Difficult and Compromised Airway

“…Having used cervical epidural commonly for pain management, we choose to use CEA because of our familiarity with the technique. Cervical epidural anesthesia has been used for thyroidectomy, carotid artery surgery, and other neck surgeries [10,20,21,22]. Some of the advantages of CEA over the other forms of regional anesthesia include the ability to prolong anesthesia and provide excellent post-operative analgesia because of the placement of a catheter, and the sympathetic blockade produced reduces blood loss.…”

Comparative evaluation of dexmedetomidine and clonidine with low dose ropivacaine in cervical epidural anesthesia for modified radical mastectomy: A prospective randomized, double-blind study

“…Many studies have observed the adverse events such as bradycardia, hypotension, and acute ventilatory failure due to the administration of high concentration local anesthetics. [ 20 21 ]…”