Mukhopadhyay Sandip, Niyogi Mausumi, Dutta Manotosh, Ray Ritam, Gayen Ganesh Chandra, Mukherjee Monoj, Mukhopadhyay Basabdatta Samanta
Department of Pharmacology, Christian Medical College, Ludhiana, Punjab.
Local Reg Anesth. 2012;5:1-7. doi: 10.2147/LRA.S28360. Epub 2012 Feb 17.
General anesthesia is commonly used for surgery in the neck region. Superficial cervical plexus block is adequate to produce anesthesia in the anterior and anterolateral aspects of the neck. Our aim was to observe the effectiveness of bilateral cervical plexus block for surgery in this region of the neck.
A total of 136 neck surgery cases were enrolled in this prospective uncontrolled study. All patients were administered ropivacaine 0.5% as a bilateral cervical plexus block. The incision line was infiltrated with lignocaine 1% and adrenaline 1:100,000. For thyroglossal cyst and thyroglossal fistula, an additional 1.5 mL of LA solution was deposited over the hyoid bone on both sides of the midline. Any anesthetic inadequacy was corrected using ketamine 25 mg intravenously and repeated if necessary.
Of 37 patients with thyroglossal cyst, the block was sufficient in 36 patients, and one patient required ketamine. Block was adequate in 23 of 24 patients with thyroglossal fistula, and one patient required ketamine. Among the branchial cyst and branchial fistula cases, six of 16 patients required ketamine supplementation. Of three thyroidectomy patients, one required ketamine supplementation, and one was converted to conventional general anesthesia. For lymph node excision and lymph node biopsy patients, LA block was sufficient in all 31 cases. In the last group, one of 25 patients required ketamine supplementation.
The overall success of bilateral cervical plexus block as a sole method of anesthesia in these selected neck surgeries was 91.9% and with low-dose ketamine supplementation it approached more than 99%. However, cervical plexus block was not a good method of anesthesia for thyroid surgery in this study. For the remainder of cases, bilateral cervical plexus block alone or in conjunction with ketamine appeared to be a cheap, safe, and effective alternative to conventional general anesthesia.
全身麻醉常用于颈部手术。颈浅丛阻滞足以在颈部前方和前外侧产生麻醉效果。我们的目的是观察双侧颈丛阻滞用于该颈部区域手术的有效性。
本前瞻性非对照研究共纳入136例颈部手术病例。所有患者均接受0.5%罗哌卡因双侧颈丛阻滞。切口线用1%利多卡因和1:100,000肾上腺素浸润。对于甲状舌管囊肿和甲状舌管瘘，在中线两侧的舌骨上额外注入1.5 mL利多卡因溶液。若麻醉不足，静脉注射25 mg氯胺酮进行纠正，必要时重复使用。
37例甲状舌管囊肿患者中，36例阻滞充分，1例患者需要氯胺酮。24例甲状舌管瘘患者中有23例阻滞充分，1例患者需要氯胺酮。在鳃裂囊肿和鳃裂瘘病例中，16例患者中有6例需要补充氯胺酮。3例甲状腺切除术患者中，1例需要补充氯胺酮，1例改为传统全身麻醉。对于淋巴结切除和淋巴结活检患者，所有31例患者的利多卡因阻滞均充分。在最后一组中，25例患者中有1例需要补充氯胺酮。
在这些选定的颈部手术中，双侧颈丛阻滞作为单一麻醉方法的总体成功率为91.9%，补充小剂量氯胺酮后接近99%以上。然而，在本研究中，颈丛阻滞不是甲状腺手术的良好麻醉方法。对于其余病例，单独或联合氯胺酮使用双侧颈丛阻滞似乎是一种比传统全身麻醉更便宜、安全且有效的替代方法。
