Ann Surg Treat Res.  2015 Dec;89(6):325-329. 10.4174/astr.2015.89.6.325.

Analgesic efficacy of bilateral superficial and deep cervical plexus block in patients with secondary hyperparathyroidism due to chronic renal failure

• Su Y
• Zhang Z
• Zhang Q
• Zhang Y
• Liu Z

• KMID: 2148308
• DOI: http://doi.org/10.4174/astr.2015.89.6.325

Abstract

PURPOSE
Secondary hyperparathyroidism (SHPT) develops in patients with chronic renal failure. This study aimed to compare analgesic efficacy in SHPT patients who undergo subtotal parathyroidectomy after superficial versus deep cervical plexus block.
METHODS
Sixty chronic renal failure patients with SPHT scheduled for subtotal parathyroidectomy were randomized to receive general anesthesia (group GA), general anesthesia plus bilateral superficial and deep cervical plexus block (group BD), or general anesthesia plus bilateral superficial cervical plexus block (group BS) (n = 20). Bilateral superficial cervical plexus block or combined superficial and deep cervical plexus block with 0.5% ropivacaine was administered. Postoperative pain was assessed using visual analogue scale (VAS).
RESULTS
VAS score at 1 hour, 4 hours, and 8 hours after operation was 3.71 +/- 0.60, 2.72 +/- 0.54, 2.17 +/- 0.75 in BS group; 4.00 +/- 0.28, 2.89 +/- 0.21, and 2.46 +/- 1.01 in BD group, significantly lower than in GA group (6.50 +/- 0.50, 5.02 +/- 0.54, and 4.86 +/- 0.51, respectively). The dosage of tramadol was 109.0 +/- 35.2 mg in BS group and 93.0 +/- 24.52 mg in BD group, significantly lower than in GA group (300.0 +/- 27.13 mg). The incidence of complications in GA group (90%) was significantly higher than in BS group (30%) and BD group (15%). Serum glucose and norepinephrine levels were significantly higher at 1 hour, 4 hours, and 8 hours after operation, but returned to baseline levels at 24 hours after operation.
CONCLUSION
Superficial cervical plexus block or combined superficial and deep cervical plexus block effectively reduces postoperative pain, stress response, and complications in SHPT patients who undergo subtotal parathyroidectomy.

Keyword

Secondary hyperparathyroidism; Chronic kidney failure; Parathyroidectomy; Cervical plexus

MeSH Terms

Anesthesia, General
Blood Glucose
Cervical Plexus*
Humans
Hyperparathyroidism, Secondary*
Incidence
Kidney Failure, Chronic*
Norepinephrine
Pain, Postoperative
Parathyroidectomy
Tramadol
Norepinephrine
Tramadol

Reference

1. de Francisco AL. Secondary hyperparathyroidism: review of the disease and its treatment. Clin Ther. 2004; 26:1976–1993.

2. Drueke TB. Cell biology of parathyroid gland hyperplasia in chronic renal failure. J Am Soc Nephrol. 2000; 11:1141–1152.

3. de Francisco AL. New strategies for the treatment of hyperparathyroidism incorporating calcimimetics. Expert Opin Pharmacother. 2008; 9:795–811.

4. Schlosser K, Endres N, Celik I, Fendrich V, Rothmund M, Fernandez ED. Surgical treatment of tertiary hyperparathyroidism: the choice of procedure matters! World J Surg. 2007; 31:1947–1953.

5. Saxe AW, Brown E, Hamburger SW. Thyroid and parathyroid surgery performed with patient under regional anesthesia. Surgery. 1988; 103:415–420.

6. Ozsoy M, Gonul Y, Bal A, Ozkececi ZT, Celep RB, Adali F, et al. Effect of IL-18 binding protein on hepatic ischemia-reperfusion injury induced by infrarenal aortic occlusion. Ann Surg Treat Res. 2015; 88:92–99.

7. Weissman C. The metabolic response to stress: an overview and update. Anesthesiology. 1990; 73:308–327.

8. Kang KH, Kim BS, Kang H. The benefits of preincision ropivacaine infiltration for reducing postoperative pain after robotic bilateral axillo-breast approach thyroidectomy: a prospective, randomized, double-blind, placebo-controlled study. Ann Surg Treat Res. 2015; 88:193–199.

9. Dieudonne N, Gomola A, Bonnichon P, Ozier YM. Prevention of postoperative pain after thyroid surgery: a double-blind randomized study of bilateral superficial cervical plexus blocks. Anesth Analg. 2001; 92:1538–1542.

10. Dony P, Dewinde V, Vanderick B, Cuignet O, Gautier P, Legrand E, et al. The comparative toxicity of ropivacaine and bupivacaine at equipotent doses in rats. Anesth Analg. 2000; 91:1489–1492.

11. Kim YK, Hwang GS, Huh IY, Hwang JH, Park JY, Chung SL, et al. Altered autonomic cardiovascular regulation after combined deep and superficial cervical plexus blockade for carotid endarterectomy. Anesth Analg. 2006; 103:533–539.

12. Shih ML, Duh QY, Hsieh CB, Liu YC, Lu CH, Wong CS, et al. Bilateral superficial cervical plexus block combined with general anesthesia administered in thyroid operations. World J Surg. 2010; 34:2338–2343.

13. Cai HD, Lin CZ, Yu CX, Lin XZ. Bilateral superficial cervical plexus block reduces postoperative nausea and vomiting and early postoperative pain after thyroidectomy. J Int Med Res. 2012; 40:1390–1398.

14. Cheong YT, Taib NA, Normayah K, Hisham AN. Total parathyroidectomy under local anaesthesia for renal hyperparathyroidism. Asian J Surg. 2009; 32:51–54.

15. Suh YJ, Kim YS, In JH, Joo JD, Jeon YS, Kim HK. Comparison of analgesic efficacy between bilateral superficial and combined (superficial and deep) cervical plexus block administered before thyroid surgery. Eur J Anaesthesiol. 2009; 26:1043–1047.