Alseoudy M M, Elzahaby I A, Elebedy D A
Department of Anaesthesia, Surgical Intensive Care and Pain Management Mansoura University Hospitals Mansoura Egypt.
Department of Surgical Oncology Oncology Centre Mansoura University Mansoura Egypt.
Anaesth Rep. 2025 Apr 7;13(1):e70007. doi: 10.1002/anr3.70007. eCollection 2025 Jan-Jun.
Fascial plane blocks for thoracic and neck surgery provide not only peri-operative analgesia but also serve as an effective alternative to general anaesthesia when combined with procedural sedation. Hemithyroidectomies are commonly performed by an open technique involving a transverse neck incision. Minimally invasive endoscopic approaches can offer cosmetic benefits, quicker recovery and reduced need for analgesia. Avoiding general anaesthesia may reduce complications, such as pulmonary atelectasis and cardiovascular instability, which may be of benefit to patients at increased risk. We describe the use of a combination of fascial plane blocks (superficial cervical plexus block, clavipectoral fascia plane block, interpectoral plane block and pectoserratus plane block) and dexmedetomidine sedation for a 65-year-old patient who had previously experienced accidental awareness under general anaesthesia and was very keen to avoid another general anaesthetic. The procedure was uneventful, with minimal bleeding and stable respiratory and haemodynamic parameters throughout. The patient was extremely satisfied with the anaesthetic technique and the cosmetic results of the surgery. We propose that fascial plane blocks along with dexmedetomidine sedation can be an effective alternative to general anaesthesia for endoscopic hemithyroidectomy in selected patients.
用于胸颈部手术的筋膜平面阻滞不仅能提供围手术期镇痛，而且与程序性镇静联合使用时，可作为全身麻醉的有效替代方法。甲状腺半切除术通常采用开放式技术，通过颈部横向切口进行。微创内镜手术方法具有美容效果好、恢复快和镇痛需求减少等优点。避免全身麻醉可能会减少诸如肺不张和心血管不稳定等并发症，这对风险增加的患者可能有益。我们描述了对一名65岁患者使用筋膜平面阻滞（颈浅丛阻滞、锁胸筋膜平面阻滞、胸肌间平面阻滞和胸大肌平面阻滞）与右美托咪定镇静相结合的方法，该患者曾在全身麻醉下意外知晓，非常渴望避免再次接受全身麻醉。手术过程顺利，出血极少，整个过程中呼吸和血流动力学参数稳定。患者对麻醉技术和手术的美容效果非常满意。我们认为，对于选定的患者，筋膜平面阻滞联合右美托咪定镇静可作为内镜下甲状腺半切除术全身麻醉的有效替代方法。
