Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Palandöken, 25070, Erzurum, Turkey.
Department of Anaesthesiology, Regional Training and Research Hospital, Erzurum, Turkey.
J Anesth. 2018 Apr;32(2):219-226. doi: 10.1007/s00540-018-2468-x. Epub 2018 Feb 21.
The postoperative analgesic effect of tizanidine has not yet been evaluated sufficiently. The role of bilateral superficial cervical plexus block (BSCPB) for postoperative analgesia after thyroidectomy remains questionable. We aimed to evaluate the analgesic effect of combined use of BSCPB and a single-dose oral tizanidine in patients undergoing elective thyroid surgery.
Sixty patients undergoing thyroidectomy were randomized into 3 groups. The control group (Group C, n = 20) received BSCPB with 0.9% saline plus oral placebo. The superficial cervical group (Group SC, n = 20) received BSCPB with 0.25% bupivacaine plus oral placebo. The superficial cervical and tizanidine group (Group SC + T, n = 20) received BSCPB with 0.25% bupivacaine plus tizanidine 6 mg capsule. Surgical site pain scores, opioid consumption, rescue analgesia, posterior neck pain, headache, and opioid-related side effects were assessed for the first 24 h.
Compared with Group C, rest and swallowing pain scores in Group SC and Group SC + T were statistically lower at all postoperative time points (p < 0.05). Fentanyl consumption was lower in Group SC and Group SC + T than in Group C at time periods 0-4 and 4-8 h (p < 0.05). Fentanyl consumption was lower in Group SC + T than in Group SC at 0-4 h (p = 0.006). Total fentanyl consumption was higher in Group C than in the other groups (p < 0.001). Postoperative cervical pain and occipital headache were significantly lower in Group SC + T than in the other groups (p < 0.05).
Ultrasound-guided BSCPB with or without preemptive oral tizanidine was effective at reducing postoperative pain and opioid consumption in patients undergoing total thyroidectomy. Addition of preemptive oral tizanidine to BSCPB reduced the early postoperative opioid consumption, posterior neck pain, and occipital headache.
The study was registered with a clinical trials registry (ClinicalTrials.gov. identifier NCT02725359).
替扎尼定的术后镇痛效果尚未得到充分评估。颈浅丛双侧阻滞（BSCPB）在甲状腺手术后的镇痛作用仍存在争议。我们旨在评估 BSCPB 联合单次口服替扎尼定在择期甲状腺手术患者中的镇痛效果。
60 例行甲状腺切除术的患者被随机分为 3 组。对照组（C 组，n=20）接受 0.9%生理盐水 BSCPB 加口服安慰剂。颈浅丛阻滞组（SC 组，n=20）接受 0.25%布比卡因 BSCPB 加口服安慰剂。颈浅丛和替扎尼定组（SC+T 组，n=20）接受 0.25%布比卡因 BSCPB 加替扎尼定 6mg 胶囊。评估术后 24 小时内的手术部位疼痛评分、阿片类药物用量、解救性镇痛、颈后疼痛、头痛和阿片类药物相关副作用。
与 C 组相比，SC 组和 SC+T 组在所有术后时间点的静息和吞咽疼痛评分均显著降低（p<0.05）。与 C 组相比，SC 组和 SC+T 组在 0-4 小时和 4-8 小时时芬太尼的消耗量较低（p<0.05）。与 SC 组相比，SC+T 组在 0-4 小时时芬太尼的消耗量较低（p=0.006）。C 组的总芬太尼消耗量高于其他组（p<0.001）。与其他组相比，SC+T 组术后颈痛和枕部头痛明显更低（p<0.05）。
超声引导下颈浅丛阻滞联合或不联合术前口服替扎尼定可有效减轻甲状腺全切除术患者的术后疼痛和阿片类药物用量。BSCPB 联合术前口服替扎尼定可减少术后早期阿片类药物的消耗、颈后疼痛和枕部头痛。
该研究在临床试验注册库（ClinicalTrials.gov，注册号 NCT02725359）注册。
