Wilson Laura, Malhotra Rajiv, Mayhew David, Banerjee Arnab
Department of Anaesthesia, Liverpool University Hospitals NHS Trust, Royal Liverpool University Hospital, Mount Vernon Street, Liverpool, England.
Department of Anaesthesia, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, England.
Indian J Anaesth. 2023 Jul;67(7):579-589. doi: 10.4103/ija.ija_806_22. Epub 2023 Jul 14.
Thyroid surgery is moderately painful, and many techniques to reduce postoperative pain have been studied. Regional techniques are a part of multimodal analgesia employed for various surgical cases. Bilateral superficial cervical plexus block (BSCPB) is a commonly used regional anaesthesia technique for analgesia for thyroid surgery. A previous meta-analysis by this group had left questions about some facets of the technique, to which further trials have contributed.
The systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) CRD42022315499. It is an update to a previously published paper in 2018. An updated systematic search, critical appraisal, and analysis of clinical trials were performed. Trials investigating preoperative or postoperative BSCPB compared to control in patients undergoing thyroid surgery were included in the search. The primary outcome was postoperative opioid consumption. The secondary outcomes were the duration of analgesia (time to request of analgesia), Visual Analogue Scale (VAS) pain scores at 0, 4, 12, and 24 h, postoperatively, rates of postoperative nausea and vomiting (PONV), postoperative rescue analgesic consumption, and intraoperative morphine use.
A total of 31 studies and 2,273 patients were included in this analysis. BSCPB significantly reduced post-thyroidectomy opioid consumption ( < 0.001). Additionally, the duration of analgesia was prolonged following BSCPB. VAS scores for 24 h (postoperatively), intraoperative morphine use, and rescue analgesia (postoperatively) remained significantly lower in patients who received BSCPB. There was also a statistically significant reduction in PONV ( = 0.02).
BSCPB offers superior postoperative analgesia with a reduction in opioid use, reduction in PONV, and improvement in VAS scores.
甲状腺手术会带来中度疼痛，人们已经研究了多种减轻术后疼痛的技术。区域技术是用于各类手术病例的多模式镇痛的一部分。双侧颈浅丛阻滞（BSCPB）是甲状腺手术镇痛常用的区域麻醉技术。该研究团队之前的一项荟萃分析对该技术的某些方面存在疑问，后续试验对此有所贡献。
该系统评价和荟萃分析已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42022315499。这是对2018年发表的一篇论文的更新。进行了更新的系统检索、批判性评价以及对临床试验的分析。检索纳入了比较甲状腺手术患者术前或术后BSCPB与对照组的试验。主要结局是术后阿片类药物消耗量。次要结局包括镇痛持续时间（请求镇痛的时间）、术后0、4、12和24小时的视觉模拟评分（VAS）疼痛评分、术后恶心呕吐（PONV）发生率、术后补救性镇痛药物消耗量以及术中吗啡使用量。
本分析共纳入31项研究和2273例患者。BSCPB显著降低了甲状腺切除术后的阿片类药物消耗量（<0.001）。此外，BSCPB后镇痛持续时间延长。接受BSCPB的患者术后24小时的VAS评分、术中吗啡使用量以及术后补救性镇痛（药物消耗量）仍显著较低。PONV也有统计学显著降低（=0.02）。
BSCPB提供了更好的术后镇痛效果，减少了阿片类药物的使用，降低了PONV发生率，并改善了VAS评分。
