Pintaric Tatjana Stopar, Hocevar Marko, Jereb Simona, Casati Andrea, Novak Jankovic Vesna
Department of Anesthesiology, Institute of Oncology, Ljubljana, Slovenia.
Anesth Analg. 2007 Oct;105(4):1160-3, table of contents. doi: 10.1213/01.ane.0000280443.03867.12.
Minimally invasive parathyroidectomy (MIP) can be performed under cervical plexus block (CPB). Superficial CPB has been reported to be easier to perform with similar efficacy and less anesthesia-related complications than combined deep and superficial CPB. In this study, we compared the efficacy of superficial and combined (deep and superficial) CPB in patients undergoing MIP.
Forty-two patients with primary hyperparathyroidism due to a solitary adenoma were randomized to receive either a superficial (group superficial, n = 20) or a combined deep and superficial CPB (group combined, n = 22) using 0.35 mL/kg of 0.5% levobupivacaine. The primary end-point was the amount of supplemental fentanyl required to complete surgery.
There were no differences in onset of block, pain scores during surgery, or time to first analgesic request between groups. Fentanyl consumption was similar in both groups, i.e., 50 (0-200) microg in group superficial and 50 (0-100) microg in group combined (P = 0.60). Six patients [1 in group superficial (5%) and 5 in group combined (22.7%)] were converted to general anesthesia for surgically required bilateral neck dissection (P = 0.18). General anesthesia for block failure was reported in three superficial (15%) and two combined group patients (9%) (P = 0.99). In group combined, only one patient (4.5%) showed diaphragmatic paresis after the block (P = 0.99).
Superficial CPB is an alternative to combined block for MIP.
微创甲状旁腺切除术（MIP）可在颈丛阻滞（CPB）下进行。据报道，与深部和浅部联合颈丛阻滞相比，浅部颈丛阻滞操作更容易，疗效相似，且麻醉相关并发症更少。在本研究中，我们比较了浅部和联合（深部和浅部）颈丛阻滞在接受MIP患者中的疗效。
42例因单发腺瘤导致原发性甲状旁腺功能亢进的患者被随机分为两组，分别接受浅部颈丛阻滞（浅部组，n = 20）或深部和浅部联合颈丛阻滞（联合组，n = 22），使用0.35 mL/kg的0.5%左旋布比卡因。主要终点是完成手术所需的追加芬太尼量。
两组之间在阻滞起效时间、手术期间疼痛评分或首次要求镇痛的时间方面没有差异。两组的芬太尼消耗量相似，浅部组为50（0 - 200）μg，联合组为50（0 - 100）μg（P = 0.60）。6例患者[浅部组1例（5%），联合组5例（22.7%）]因手术需要进行双侧颈部清扫而转为全身麻醉（P = 0.18）。浅部组有3例（15%）和联合组有2例（9%）患者因阻滞失败而采用全身麻醉（P = 0.99）。在联合组中，只有1例患者（4.5%）在阻滞后出现膈肌麻痹（P = 0.99）。
浅部颈丛阻滞是MIP联合阻滞的一种替代方法。
