Efficacy Of Ultrasound Guided Bilateral Superficial Cervical Plexus Block Under General Anesthesia For Thyroidectomy

Objective:To investigate the efficacy of ultrasound guided bilateral superficial cervical plexus block under general anesthesia for thyroidectomy.Methods:120 ASA physical status I or II,female,aged 20-70 yr,weighted 45-85 kg and scheduled for thyroid surgery were enrolled in the study.General anesthesia was induced with midazolam 0.03mg/kg intravenously(i.v.),propofol 2mg/kg(i.v.),sufentanil 0.5ug/kg(i.v.),vecuronium 0.05mg/kg(i.v.).Until loss of eyelash reflexes,tracheal intubation was performed with endotracheal tube for laryngeal recurrent nerve monitoring under glidescope.Anesthesia was maintained with inhalation of desflurane under mechanical ventilation.Patients were randomized to four groups: Group A(n=30),general anesthesia with PCIA,Group B(n=30),general anesthesia without PCIA,Group C(n=30),bilateral superficial cervical plexus block(BSCPB)with PCIA,Group D(n=30),BSCPB without PCIA.BSCPB was performed with 14 ml 0.33% ropivacaine under ultrasound.Record intraoperative analgesic(sufentanil)requirements 、 postoperative VAS of pain and PONV in 48 hours,the time of ingress、fart、defecation、off-bed activity in 24 hours,and SBP、DBP、MAP、HR of baseline(5min before anesthesia)、T1(5min after intubation)、T2(10min after surgery)、T3(end of surgery)、T4(extubation).Results:In A、B groups,SBP、DBP、MBP、HR at T1、T2、T3、T4 were significantly higher than those at baseline(P<0.05).In C and D groups,hemodynamic parameters at T1、T2、T3 were slightly higher than those at baseline(P>0.05)and significantly higher at T4(P<0.05),but showed no significant differences(P>0.05).Hemodynamic parameters at T1、T2、T3 were significantly different between A、B groups and C、D groups(P<0.05).The average sufentanil requirements and VAS score was significantly lower in group C and group D(P<0.05),but showed no significant differences(P>0.05),and VAS score in group B was higher than that of group A(P<0.05).PONV VAS score in A、B、C groups were higher than that of group D,A、B groups were higher than group C and the score of group B was obviously highest.A、B groups took more time to do off-bed activity than C、D groups,and group A took more time than group B.The number of cases of farting or defecation in A、B groups are significantly higher than those in C、D groups in 24 hours after surgery.Conclusion:The efficacy of ultrasound guided bilateral superficial cervical plexus block under general anesthesia for thyroidectomy is more remarkable than general anesthesia in analgesia and antiemetic effect.It contributes to making patients restore and maintain circulation stabilization,decreacing the incidence rate of complications and accelerating the postoperative recovery.