Local and Regional Anesthesia (Apr 2021)
Effects of Ultrasound-Guided Bilateral Cervical Plexus Block Combined with General Anesthesia in Patients Undergoing Total Parathyroidectomy and Partial Gland Autotransplantation Surgery
Abstract
Jing Gong,1 Youxiu Yao,2 Yanbiao Wang3 1Department of Anesthesiology, The 960th Hospital of the People’s Liberation Army Joint Logistical Support Force, Jinan, Shandong, People’s Republic of China; 2Department of Anesthesiology, Peking University Third Hospital, Beijing, People’s Republic of China; 3Department of Orthopaedics, The 960th Hospital of the People’s Liberation Army Joint Logistical Support Force, Jinan, Shandong, People’s Republic of ChinaCorrespondence: Youxiu YaoDepartment of Anesthesiology, Peking University Third Hospital, Beijing, People’s Republic of ChinaTel +8618810488772Email [email protected]: The aim of this study is to evaluate the effect of ultrasound-guided bilateral cervical plexus block on general anesthesia, postoperative analgesia, and surgical outcomes in patients undergoing total parathyroidectomy with autotransplantation.Patients and Methods: Forty-eight ASA III–IV patients with hyperparathyroidism secondary to renal failure were included: 24 patients received ultrasound-guided bilateral superficial and deep cervical plexus block combined with general anesthesia (group A), and 24 patients received general anesthesia alone (group B). Postoperative patient-controlled intravenous analgesia was provided with sufentanil 2 μg/kg. The primary outcome is the postoperative pain scores. Secondary outcomes include intraoperative remifentanil dosage, changes in hemodynamics, extubation time, and sufentanil consumption. Surgical outcomes regarding calcium, phosphorus and parathormone values were also noted.Results: The patients in group A required less remifentanil than group B (2.56± 0.92mg vs 3.38± 0.84mg, P=0.002) and lower VAS scores at 1, 3, 10, 24, and 48h postoperatively (P < 0.001). While the systolic blood pressure in group A patients was significantly greater than that in group B at T3 (immediately after extubation, [138.33± 11.36 vs 129.08± 17.06 mmHg; P=0.032]), heart rates in group A were lower than in group B at 1 min before induction (T1 [89.46 ± 9.14 vs 96.71± 14.19, P=0.042]) and 1 min after intubation (T2 [70.08 ± 5.35 vs 79.25 ± 11.81, P=0.002]). The extubation time in group A was shorter than that in group B (P < 0.001). There was no difference in calcium, phosphorus and parathormone values, nor in sufentanil consumption between the groups.Conclusion: Ultrasound-guided bilateral superficial and deep cervical plexus block combined with general anesthesia for TPTA is an effective strategy to improve anesthesia management and achieve better postoperative analgesia, and has no impact on surgical outcomes.Keywords: ultrasound guidance, cervical plexus block, hyperparathyroidism, renal failure
