Feasibility of ultrasound-guided capsule-sheath space block combined with anterior cervical cutaneous nerves block for thyroidectomy: an observational pilot study |
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Authors: | Quanguang Wang Zhengqian Li Shihao Xu Yu Li Xuezheng Zhang Qimin Liu Yun Xia Thomas J Papadimos Xuzhong Xu |
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Affiliation: | .Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Zhejiang, China ;.Department of Anesthesiology, Peking University Third Hospital, Beijing, China ;.Department of Anesthesiology, Yongjia People’s Hospital, Zhejiang, China ;.Department of Anesthesiology, Ohio State University Medical Center, Ohio, USA |
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Abstract: | BackgroundWe evaluated the efficacy of a new anesthetic technique termed ultrasound-guided capsule-sheath space block (CSSB) combined with anterior cervical cutaneous nerve block (CCNB) for thyroidectomy.MethodsThe study included two parts: Part one was an imaging study to determine technique feasibility. The CSSB was performed on five healthy volunteers by introducing the needle 0.5 cm lateral to the probe under in-plane needle ultrasound guidance. After puncture of the false capsule and its subsequent contraction with the true capsule of thyroid, 10 mL of contrast medium was deposited slowly in the capsule-sheath space. The CCNB was performed bilaterally as follows: Under ultrasound guidance, a subcutaneous injection was made along the sternocleidomastoid using 10 mL of contrast medium which was followed by a girdle-shaped picchu raised from the cricoid cartilage to supraclavicular region. The spreading pattern of contrast medium was imaged using computed tomographic scanning. In part two (a clinical case series) the technique efficacy was evaluated. Seventy-eight patients undergoing thyroidectomy had ultrasound-guided CSSB and CCNB with local anesthetics. The sensory onset of CCNB, intraoperative hemodynamic parameters, and analgesic effect were assessed and complications were noted.ResultsThe distribution of contrast medium was well defined. In part two the onset time of CCNB was 2.2 ± 0.7 min, and the hemodynamic parameters remained stable intraoperatively. The recall of visual analogue scale scores during surgery was 2 [1–4] for median (range). The patients’ and surgeons’ satisfaction scores were 2 [1–4] and 1 [1–3] for median (range). No serious complications occurred.ConclusionsCombining ultrasound-guided CSSB and CCNB is a feasible, effective and safe technique for thyroidectomy.Trial registrationCurrent Controlled Trials ChiCTR-ONC-12002025. Registered 19 March 2012. |
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Keywords: | Regional anesthesia Ultrasound guidance Thyroidectomy Contrast medium Ropivacaine |
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