Ultrasound-guided intermediate cervical plexus block effects on per and post-operative opioids consumption during total thyroidectomy under general anesthesia, randomised controlled study

Background > The role of cervical plexus block in anaesthesia for post thyroidectomy under general analgesia remains controversial, and we don't find guidelines recommending this block in ENT surgery The technique of ultrasound-guided intermediate cervical plexus block (ICB) seems to be promising, we aim to clarify the contribution of this block on reduction of opioids consumption in per and postoperative during thyroidectomy under general anaesthesia and to determine the impact on analgesia, adverse effects and patient satisfaction. Methods > We performed a prospective trial with 70 patients randomised in two groups each of 35: - group 1 (GP1): bilateral echo-guided ICB by 10 ml of isobaric bupivacaine (0.25%) - group 2 (GP2): control. Ten minutes later, ICB is performed under general anaesthesia. The total dose of Remifentanil is calculated upon awakening, the postoperative pain is determined by a visual analog scale from 0 to 10 (VAS) statements to H0, H1 H2, H4, H6, H12 and H24. Whenever EVA is greater than or equal to 4, a morphine titration administered, total dose consumption, side effects and satisfaction ore noted at the end of protocol. Results > Peroperative opioid consumption was significantly decreased of more than 38% for GP1. The postoperative morphine titration request in GP1 was noted for 10 patients VS 21 in GP2. We noted nouseas and vomiting for 9 patients in GP1 against 13 in GP2. The VAS at H1 and after H12, was significant statistically higher for GP2. For GP1, 75% were satisfied VS 58% for GP2. Conclusions > ICB for total thyroidectomy under general anaesthesia allows the decrease of per and postoperative opioids, may provide a better analgesia and seems to reduce adverse events.