Subcutaneous dissection area contributes less to endoscopic thyroidectomy-related invasiveness

Abstract

Our RCT indicated that the subcutaneous area plays a less important role with regard to BAET-related postoperative pain.

Analgesic Efficacy of an Ultrasound-Guided Transversus Thoracis Plane Block Combined with an Intermediate Cervical Plexus Block on Postoperative Pain Relief After Trans-Areolar Endoscopic Thyroidectomy: A Single Center Prospective Randomized Controlled Study

“…An inappropriate plane invasion can exacerbate pain in the chest area. 3 Bijkerk et al 9 observed that blocking the anterior cutaneous branch of the T2-5 intercostal nerve significantly affected the medial breast image limit and the sensation of areola and nipple in healthy female subjects. TTPB refers to the injection of local anaesthetics between the intercostal and transversus thoracis muscles, and this fascial space is perforated by the anterior cutaneous branch of the intercostal nerve, which innervates the sternum and supports internal mammary sensation.…”

“…1,2 Breast endoscopic thyroidectomy requires the establishment of artificial channels above the two nipples and under the chest wall Journal of Pain Research 2023:16 1059-1067 to separate the chest wall from the pectoralis major muscle to establish operating tunnels in the neck; thus, it is considered a minimally invasive surgery with great invasiveness. 3 A total of 35-65% of patients complain about moderate to severe pain after transaxillary endoscopic thyroidectomy. 4 Endoscopic thyroidectomy involves considerable subcutaneous mobilisation in the chest and parasternal areas and requires carbon dioxide inflation of the operative space, 5 therefore, patients expectedly experience pain after trans-areolar endoscopic thyroidectomy.…”

“…Primary outcome: In the chest area, the block group had lower VAS scores than the control group at 6 h after surgery at rest (block group=2 [2][3]; control group=4 [3][4]; p < 0.001) (Figure 2A).…”