甲状腺疾患と治療のジャーナル
オープンアクセス

概要

Thyroid Surgery in Local Anaesthesia: Renewal an Old Method

Bernadett Lévay, Kiss A, Zelenai F, Elek J, and Oberna F

Introduction: In the older times of thyroid surgery, the operations were performed under local anaesthesia. With the development of anaesthesia surgeons preferred to use narcosis for most thyroid surgeries. Today, however, regional anaesthesia has become popular as a safe and effective technique based on numerous clinical studies, surgeons are still keen on doing surgeries under general anaesthesia. Regional anaesthesia is indicated in high risk patients and also in case of pregnancy, but in well-fit patients it could lead to faster recovery. In case of a substernal goitre or infiltrating carcinoma or in case of severe bleeding disables general anaesthesia should be chosen.
Patient materials and methods: At the Department of Multidisciplinary Head and Neck Cancer Center in the National Institute of Oncology between May 2019 and March 2020, 9 patients underwent thyroid or parathyroid operations in regional anaesthesia: 7 patients had lobectomy, 1 patient had thyroidectomy, and 1 patient had parathyroid adenoma removal. In all cases, the regional anaesthesia involved the blockage of the superficial branches of the cervical plexus, followed by an ultrasound guided thyroid capsule sheath space block. Patients were previously given 2 mg of i.v. midazolam, and in case of need 50 ug of i.v. fentanyl under haemodynamic monitoring.
Results: One patient had a transient Horner’s syndrome. The average time of the surgery was 42.7 minutes (25-80 minutes). All patients tolerated the procedures very well. The incidence of postoperative pain, such as nausea and vomiting were reduced. Patients could be discharged earlier and they had a faster recovery.
Conclusion: Based on our limited experience, regional nerve block anaesthesia for uncomplicated thyroid and parathyroid patients offers several advantages, and provides superior postoperative nausea, and pain control.