Pre-Incision Infiltration of Local Anesthetic Reduces Postoperative Pain with No Effects on Bruising and Wound Cosmesis After Thyroid Surgery

Abstract

Optimizing postoperative pain control is an important aspect in perioperative patient care. The aim of this study was to investigate the efficacy of preincision local anesthetic infiltration in postoperative pain management for thyroid surgery and its relationship to bruising and wound cosmesis. In a randomized single-blinded study, 39 consecutive patients listed for thyroid surgery were assigned into two groups. Group I (n = 19) received subcuticular preincision infiltration with 10 ml of bupivacaine (0.5%) and Group II (n = 20) received no infiltration. Postoperatively, the pain experienced was evaluated by two methods: verbal response scores and linear analogue scores (0-100 mm) at different time intervals following surgery. Bruising and cosmetic effects resulting from surgery were assessed using a linear analogue score at discharge. The two groups were well matched for confounding variables. Pain scores were significantly different at 6 hours post operatively (p = 0.0341) with mean scores Group I = 33 and Group II = 50, but this difference disappeared at 24 hours. No patients (0%) received IV morphine in Group I compared to 5 patients (25%) in Group II. There was no significant difference in the mean bruising scores (p = 0.8864) and mean cosmetic scores (p = 0.3339) at discharge. Preincision infiltration with bupivacaine provides easy and better analgesic control postoperatively in patients following thyroid surgery with no effects on bruising or wound cosmesis.

The Effects of Preincisional Levobupivacaine Infiltration on Extubation Comfort, Postoperative Recovery and Visual Analogue Scale in Appendectomy Patients

“…They concluded that this method was safe and effective. Bagul et al (12) infiltrated subcutaneous 10 mL of 0.5% bupivacaine preincisionally in thyroidectomy patients, and they found that pain scores were 33 and 50 in the bupivacaine-infiltrated and control groups, respectively, at first sixth hour, but there was not any difference at the 24 th hour. There was no requirement of morphine in the bupivacaine group, but it was 25% in the control group.…”

The Effect of Local Anesthetic Infiltration Around Nephrostomy Tract on Postoperative Pain Control after Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

“…A randomized trial by Bagul et al [23] found that preincision infiltration with local anesthetic provided easy access and scores in analgesic control postoperatively in patients undergoing thyroid surgery with no effects on bruising or cosmesis. Rawal et al [24] discovered that pain relief after ambulatory breast augmentation was superior with incisional patient-control regional analgesia under local anesthesia when compared to oral analgesic.…”

Postoperative Intravenous Patient-Controlled Analgesia in Thyroid Surgery: Comparison of Fentanyl and Ondansetron Regimens With and Without the Nonsteriodal Anti-Inflammatory Drug Ketorolac

“…The most common type of headache was an occipital headache. Gozal et al (6) and Bagul et al (21) reported that bupivacaine wound infiltration reduced postoperative pain and opioid demand in thyroid surgery. Han et al (24) reported that greater occipital nerve block with bupivacaine reduced occipital headache and posterior neck pain after thyroid surgery.…”

“…There are well-designed studies investigating postoperative pain control, such as local anesthetic wound infiltration (6,21), bilateral superficial cervical plexus block (7,22,23), and greater occipital nerve block (24) in thyroid surgery, but the efficacy of intravenous PCA (IV PCA) in thyroid surgery has not yet been assessed. The aim of this study was to compare the analgesic efficacy and side effects of three PCA regimens using fentanyl (opioid) and ketorolac (NSAID) and to determine the appropriate dosage of fentanyl and ketorolac in patients after thyroid surgery.…”