| Objective:At present the morbidity of thyroid diseases including thyroid adenoma,thyroid cyst,etc.is increasingly ascending,but partial thyroidectomy is the most effective therapy presently.With the development of rapid rehabilitation concept,that how to promote postoperative rapid rehabilitation has become the key point which is concerned,therefore surgery put forward higher requirement for anesthetist.At present the morbidity of thyroid diseases including thyroid adenoma,thyroid cyst,etc.is increasingly ascending,but partial thyroidectomy is the most effective therapy presently.With the development of rapid rehabilitation concept,that how to promote postoperative rapid rehabilitation has become the key point which is concerned,therefore surgery put forward higher requirement for anesthetist.With the development of day operation,hospitalization operation mode has converted into the day operation mode for thyroid operation in more and more hospitals.As for the previous anesthesia ways for thyroid operation which was governed by general anesthesia with trachea cannula,adverse reactions including unstable intraoperative haemodynamics,postoperative recovery delayed,agitation,nausea and vomiting,etc.existed for patients due to application of a multitude of opioids in operation.Some studies showed that moderate and severe pain existed mostly in the course of deglutition after thyroid operation.Postoperative acute pain caused by deglutition,sound production,cough,etc.after thyroid operation not only influenced healing of incision,but also badly influenced patients’ psychological and metal state.Furthermore,stress reaction caused by postoperative pain prolonged rehabilitation time for patients,it did not facilitate rapid postoperative rehabilitation for patients.Local incision infiltration always acts as the postoperative analgesia for thyroid operation,it can block transmission of peripheral nerve signal of incision,so that a certain analgesia effect can be reached.But it frequently comes with incomplete analgesia.Traditional venous self-control analgesic pump which is inconvenient to be taken with also bring about such adverse reactions as nausea,vomiting,excessive sedation,etc.due to application of opioids,so it is not suitable for day operation.In recent years,as ultrasound visualization technology is applied,regional nerve block(RNB)is increasingly applied clinically.Conducting nerve puncture under the guidance of ultrasound can make operators clearly see the position of nerve and puncture needle,as well as the diffusion of local anesthetics,so that success rate of puncture is increased,complications caused by puncture are reduced,dosage of local anesthetics is reduced as well.Superficial cervical plexus block is a kind of nerve block way mostly used in clinic presently.It was reported that superficial cervical plexus block could be effectively used for thyroid operation.It could provide intra-and postoperative analgesia for thyroid operation.Additionally,superficial cervical plexus block combined with general analgesia could reduce application of opioids in operation,so as to keep stability of intraoperative haemodynamics,reduce postoperative tube-drawing reaction,lower the occurrence rate of such complications as postoperative agitation,delayed recovery,nausea and vomiting,etc.as well.Superficial cervical plexus block can provide effective intraoperative and postoperative analgesia effect for thyroid operation,but the patients who were conduced with superficial cervical plexus block still suffer from apparent pain in the event of postoperative early deglutition and cough.Cervical nerves pathway(CNP)is a kind of new RNB technology.Studies showed that CNP had the effect of nervus cutaneus nerve block,similar to that of superficial cervical plexus block,so CNP applying to neck operative not only could provide effectively postoperative analgesia effect,but also came with better analgesia effect for early motion pain possibly.CNP applying to day operation of thyroid come with better application prospect probably.The patients who were conducted with thyroid operation may suffer from a certain inflammatory reaction before and after the operation due to such stimulation as surgical operation,postoperative pain,etc.Especially postoperative trauma can cause the release of postoperative inflammatory factor which can further increase the patients’ pain.The level of in vivo serum tumor necrosis factor--α(TNF-α)and-6(IL-6)which act as inflammation factor are closely associated with the severe degree of tissue injury caused by noxious stimulation and postoperative pain degree,so they can serve as the good indexes of postoperative inflammatory reaction.The other studies on general analgesia combined with peripheral nerve block found that nerve block could apparently reduce the release of postoperative inflammatory factor for patients,so as to enhance postoperative analgesia effect.However,there is no domestic and overseas report about inflammatory factor level for never block which is applied to thyroid operation.The study is plan to observe the influence of general analgesia combined with CNP on intraoperative and postoperative analgesia effect,and on postoperative TNF-αand IL-6.Methods:90 patients,aged 18~65,who received partial thyroidectomy under general analgesia during some period were selected,and graded into grade I-II by American Society of Anesthesiologists(ASA).The random number table was used to divide the patients into CNP group(Group T,n=30),superficial cervical plexus block group(Group N,n=30)and local incision filtration group(Group M,n=30).Patient were connected to life sign monitoring indoors.After inducement of general analgesia and before operation started,Group T and Group N were conducted with bilateral CNP under the guidance of ultrasound and bilateral superficial cervical plexus block under the guidance of ultrasound respectively,while Group M was conducted with local incision filtration by surgeon after operation ended and before suture.The patients’ operation time and dosage of of propofol and opioids in operation were recorded;the visual analogue scale(VAS)of patients in the state of still and motion(deglutition)2h,4h,8h,12 h and 24 h was recorded respectively;and the occurrence rate of such complications as postoperative nausea and vomiting,poisoning of local anesthetics,dyspnea,dyspnea,etc.were recorded;the muscular force for raising head at the end of the operation,2h,4h,h,12 h and 24 h after the operation was recorded respectively.All the patients were performed with collecting vein blood sample before the operation,6h,12 h and 24 h after the operation respectively.The vein blood sample was centrifuged and supernate was taken,then the TNF-α and IL-6 concentration of serum were detected by enzyme linked immunosorbent assay.Results:1.The difference of VAS scores in the state of still and motion(swallowing act)12h and 24 h after the operation among the three groups had no statistical significance(p>0.05).The VAS score in the state of motion at the end of the operation,2h,4h,8h after the operation for Group T were less than that for Group N and Group M,and the difference had statistical significance(p<0.001).The VAS score in the state of motion at the end of the operation,2h after the operation for Group T and Group N were less than that for Group M,and the difference had statistical significance(P<0.05).2.The dosage of propofol and remifentanil in the operation for the Group T and Group N were less than Group M,and the difference had statistical significance(P<0.05),in which the dosage for Group T was less than that for Group N.3.The occurrence rate of nausea and vomiting for Group T were less than that for Group M,and the difference had statistical significance.4.The TNF-α concentration and IL-6 concentration of serum at various time points for Group T and Group N were less than that for Group M,and the difference had statistical significance(P<0.05).There was no significant difference between group T and group N.(P>0.05)Conclusion:CNP under the guidance of ultrasound had apparent analgesia effect when it was applied to thyroid operation in the perioperative period,and it could reduce dosage of opioids,reducing postoperative complications,relieving patients’ inflammatory reaction,and facilitating rapid postoperative rehabilitation for patients as well... |
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