Effect Of An Ultrasound-Guided Transversus Thoracis Plane Block Combined With An Intermediate Cervical Plexus Block On Postoperative Analgesia After Trans-areolar Endoscopic Thyroidectomy

Objective:Endoscopic thyroidectomy via the areola approach requires dissection of a large amount of subcutaneous tissue,which can cause moderate to severe pain in the early postoperative period.The aim of this study was to investigate the analgesic effect of ultrasound-guided transversus thoracis plane block combined with Intermediate Cervical Plexus Block in the earlypostoperative period after trans-areola endoscopicthyroidectomy.Methods:Sixty-two female patients undergoing elective breast endoscopic thyroidectomy under general anesthesia in our hospital from March 2022 to September 2022 were randomly divided into transversus thoracis plane combined with intermediate cervical plexus block group(TC group)and superficial cervical plexus block group(GA group)using random number table.After induction of general anesthesia,the TC group underwent ultrasound-guided bilateral transversus thoracis plane block with 20 ml of 0.25% ropivacaine injected on each side;bilateral middle cervical plexus block with 8 ml of 0.25% ropivacaine injected on each side.In the GAgroup,bilateral superficial cervical plexus block was performed only under ultrasound,and 8 ml of 0.25% ropivacaine was injected on each side.Anesthesia was maintained with propofol and remifentanil by pump during surgery,and flurbiprofen axetil 50 mg was intravenously injected at the end of surgery.Butorphanol 1 mg was administered intravenously for analgesia postoperatively when the patient had a VAS score greater than or equal to 4 at rest or when analgesia was requested.The primary outcome measure was the resting VAS pain score in the precordial region at 2 h,6 h,12 h,and 24 h after surgery;the secondary outcome measures included the VAS pain score in the precordial region at 2 h,6 h,12 h,and 24 h after surgery,the resting and motor VAS pain score in the neck at 2 h,6 h,12 h,and 24 h after surgery,the intraoperative remifentanil consumption,the postoperative rescue analgesia rate and analgesic demand,the incidence of postoperative nausea and vomiting,the adverse reactions,and thepatient ’satisfaction score at discharge.Results:1.General data: There was no significant difference in age,height,weight,BMI,ASA grade,surgical range and surgical time between thetwo groups.2.Intraoperative and postoperative analgesia: Compared with TC group,intraoperative remifentanil dosage,postoperative rescue analgesia rate and postoperative butorphanol use werehigherin GAgroup,and the differencewas statistically significant.3.Postoperative VAS score: Compared with GAgroup,TC patients had decreased resting VAS pain score in precordial region at 6h and 12 h after operation;there was no significant difference in resting VAS pain score in precordial region at 2h and 24 h after operation between the two groups.In the motor state,the VAS scores at 2 h,6 h,12 h,and 24 h after surgery in the precordial region and neck were lower inthe TC group than in the GAgroup.4.Nausea and vomiting and patient satisfaction: The incidence of postoperative nausea and vomiting in the TC group was lower than that in the GAgroup;the satisfaction at discharge inthe TC group was higher than that in the GAgroup,all of which were statistically significant.Conclusion:Ultrasound-guided transversus thoracis plane block combined with middle cervical plexus blockcan reducethe early VAS scoreafter breastendoscopic thyroidectomy,reducethe use of opioids during and after surgery,reducethe postoperativerescue analgesiarate,reducethe postoperativenausea and vomitingrate,andimprove the patient’s treatment satisfaction.