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Table of Content Volume 9 Issue 2 - February 2019

 

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A study of general anesthesia versus cervical block for the surgery of thyroid at tertiary health care center

 

T G Poornaganesh1*, P Vasuprakash2, Nalini Muddana3, U Seshaphani4

 

1,2,3Postgraduate, 4HOD, Department of Anesthesiology, Santhiram Medical College and General Hospital Nandyal, Kurnool District Andhra Pradesh, INDIA.

Email: ganeshmostinflammable@gmail.com

 

Abstract               Background: Historically, Thyroid and parathyroid surgery was done initially under local anesthesia. Aims and Objectives: To study General anesthesia versus cervical block for the surgery of thyroid at tertiary health care center. Methodology: This was a cross-sectional study carried out at tertiary health care centre during the one year period i.e. January 2017 to January 2018. In the one year period there were 64 patients who need thyroid surgery with written and explained consent were enrolled for the study out of these 32 were given General anesthesia (Group G) and 32 were given Local anesthesia (Group L). The statistical comparison was done unpaired t-test, and calculated by SPSS 19 version software. Result: The average age in Group G was 38 ± 2.93 Yrs. and Group L was 37± 3.42 Yrs. was comparable with each other. The ratio of Male to Female was 1.9:1 and 2.2 : 1 was also comparable (p>0.05,X2= 0.070,df=1) The duration of Surgery (min) was significantly higher in Group G as compared to Group L - 132 ± 3.45 and 101 ± 2.45 (p<0.05,t=7.82,df=62); Post operative pain (VAS) was significantly higher i.e. 5.62 ± 3.52 and 3.45 ± 2.31 (p<0.001,t=8.12,df=62); Onset of postoperative pain (min) was significantly higher i.e. 241 ± 3.42 and 61 ± 4.12 (p<0.01,t=9.23,df=62) respectively in Group L as compared to Group G. Conclusion: It can be concluded from our study that except the duration of Surgery more in General anesthesia and Post operative pain , Onset of postoperative pain was more Local anesthesia other parameters were parameters were comparable in both the group.

Key Word: surgery of thyroid, Local anesthesia for thyroid surgery, Anesthesia in thyroid surgery.

 

 

 

INTRODUCTION

Historically, Thyroid and parathyroid surgery was done initially under local anesthesia.1,2 With the advent of safer general anesthetic techniques, the need for local anesthesia fell by the wayside. There were isolated reports of the use of local anesthesia for thyroid and parathyroid surgery until the 1990s, when favorable experience with larger groups of patients was described.3-5 With the development of minimally invasive parathyroidectomy techniques, the use of local anesthesia combined with monitored anesthesia care (MAC) became more frequent, particularly when combined with outpatient surgery.6,7 Local anesthesia for thyroid surgery can be accomplished either by a regional block of the cervical plexus (C2-C4) combined with an anterior field block8 or by an anterior field block alone.5 So we have seen comparison of General anesthesia versus cervical block for the surgery of thyroid at tertiary health care center.

 

 

 

METHODOLOGY

This was a cross-sectional study carried out at tertiary health care centre during the one year period i.e. January 2017 to January 2018. In the one year period there were 64 patients who need thyroid surgery with written and explained consent were enrolled for the study out of these 32 were given General anesthesia (Group G) and 32 were given Local anesthesia (Group L). All details of the patients like age, sex, and post operative parameters like Duration of surgery (min) , Post operative pain was measure by mean Visual Analogue Scale score (VAS) , Onset of postoperative pain (min) etc. was noted for the internal comparison . The statistical comparison was done unpaired t-test, and calculated by SPSS 19 version software.

RESULT                                        

Table 1: Distribution of the patients as per the age and sex

 

Group G (n=32)

Group L (n=32)

p-value

Average age

38 ± 2.93

37 ± 3.42

p>0.05,t=1.23,df=62

Sex

 

 

 

p>0.05,X2= 0.070,df=1

Male

11

10

Female

21

22

The average age in Group G was 38 ± 2.93 Yrs. and Group L was 37± 3.42 Yrs. was comparable with each other. The ratio of Male to Female was 1.9:1 and 2. 2: 1 was also comparable (p>0.05,X2= 0.070,df=1)

 

Table 2: Distribution of the patients as per the various parameters

 

Group G (n=32)

Group L (n=32)

p-value

Duration of surgery (min)

132 ± 3.45

101 ± 2.45

p<0.05,t=7.82,df=62

Post operative pain (VAS)

3.45 ± 2.31

5.62 ± 3.52

p<0.001,t=8.12,df=62

Onset of postoperative pain (min)

241 ± 3.42

61 ± 4.12

p<0.01,t=9.23,df=62

The duration of Surgery (min) was significantly higher in Group G as compared to Group L -132 ± 3.45 and 101 ± 2.45 (p<0.05,t=7.82,df=62);Post operative pain(VAS)was significantly higher i.e. 5.62±3.52 and 3.45±2.31 (p<0.001, t=8.12, df=62); Onset of postoperative pain (min) was significantly higher i.e. 241 ± 3.42 and 61 ± 4.12 (p<0.01,t=9.23,df=62) respectively in Group L as compared to Group G.

 

DISCUSSION

Providing safe and effective anaesthesia for thyroid surgery can sometimes become a problem for the anaesthetists. This becomes relevant especially in large goitres which compresses or deviates the trachea from its normal position. Endotracheal intubation is difficult in such cases and in large goitres can be hazardous9,10. It is possible to perform thyroidectomy under bilateral superficial or deep cervical plexus block and it is a useful alternative to general anaesthesia in particular circumstances 10-12. Also the goitre might be associated with thyroid functional disorders. Patients with both hypo and hyperthyroidism are prone to cardiac rhythm disorders which might get aggravated under the influence of general anaesthetic agents 13-15. Regional anaesthesia techniques are safer than general anaesthesia in high risk patients, where endotracheal intubation is difficult or cardiac arrhythmias are anticipated. For thyroid surgery, regional anaesthesia is not a conventionally described option. Cervical plexus block has been used for operations in the neck and shoulder, particularly on the thyroid gland. It may also be used as a modality of pain therapy in this region 14 In our study we have seen that The average age in Group G was 38 ± 2.93 Yrs. and Group L was 37± 3.42 Yrs. was comparable with each other. The ratio of Male to Female was 1.9:1 and 2.2 : 1 was also comparable (p>0.05,X2= 0.070,df=1)The duration of Surgery (min) was significantly higher in Group G as compared to Group L-132 ± 3.45 and 101 ± 2.45 (p<0.05,t=7.82,df=62); Post operative pain (VAS) was significantly higher i.e. 5.62 ± 3.52 and 3.45 ± 2.31 (p<0.001,t=8.12,df=62); Onset of postoperative pain (min) was significantly higher i.e. 241 ± 3.42 and 61 ± 4.12(p<0.01,t=9.23,df=62) respectively in Group L as compared to Group G. This was similar to Maya Belitova 16 et al they found in the LA+MAC group, pain appears earlier and is more severe (56min; VAS 6, 5) than in GA patients (223 min; VAS 1, 5; p<0.001). Otherwise all other factors were comparable in both the group. (p>0.05)

 

CONCLUSION

It can be concluded from our study that except the duration of Surgery more in General anesthesia and Post operative pain, Onset of postoperative pain was more Local anesthesia other parameters were parameters were comparable in both the group.

 

REFERENCES

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  2. Crile G, Lower WE. Anoci-association in treatment of exophthalmic goiter. In: Rowland AF. Anoci-association. Philadelphia, Pa: WB Saunders Co; 1914:190- 199.
  3. Chapuis Y, Icard P, Fulla Y, et al. Parathyroid adenomectomy under local anes thesia with intra-operative monitoring of UcAMP and/or 1-84 PTH. World J Surg. 1992; 16: 570-575.
  4. Lo Gerfo P, Gates R, Gazetas P. Outpatient and short-stay thyroid surgery. Head Neck. 1991; 13: 97-101.
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  9. Khanna R, Singh DK. Cervical epidural anaesthesia for thyroid surgery. Kathmandu Univ Med J. 2009; 7(27): 242-5.
  10.  Kolawole IK, Rahman GA. Emergency thyroidectomy in a patient with severe upper airway obstruction caused by goiter: case for regional anaesthesia. J Natl Med Assoc. 2006; 98(1): 86-9.
  11. Kulkarni RS, Braverman LE, Patwardhan NA. Bilateral cervical plexus block for thyroidectomy and parathyroidectomy in healthy and high risk patients. J Endocrinol Invest. 1996; 19(11): 714-8.
  12.  Klein SM, Greengrass RA, Knudsen N, Leight G, Warner DS. Regional anesthesia for thyroidectomy in two patients with amioderoneinduced hyperthyroidism. Anesth Analg. 1997; 85(1): 222-4.
  13. Lo Gerfo P. Outpatient thyroid surgery. J Clin Endocrinol Metab. 1998; 83(4): 1097-1100.
  14.  Lo Gerfo P, Ditkoff BA, Chabot J, Feind C. Thyroid surgery using monitored anesthesia care: an alternative to general anesthesia. Thyroid. 1994; 4(4): 437-9
  15. Farling PA. Thyroid disease. Br J Anaesth. 2000; 85(1): 15-28.
  16. Maya Belitova, Rumen Pandev, Dimitar Karadimov . General or Local Anaesthesia in One-Day Thyroid Surgery-Does It Matter? .Balkan Med J 2012; 29: 124-8.


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