Cervical plexus block for thyroidectomy

Abstract

Objective: Thyroidectomy is traditionally performed under general anaesthesia with endotracheal intubation. However, cervical plexus block has also been found useful for this operation in some parts of the world. This particular anaesthetic option has never been reported in our environment. The aims of this study were to assess the feasibility, safety, effectiveness and patients= acceptability of bilateral superficial cervical plexus block for thyroidectomy in our hospital. Design: This is a prospective study of all consenting adult patients who presented with goiter and had thyroidectomy done in a Nigerian Teaching Hospital, between May 1998 and September 1999. Setting: The study was carried out at the University of Ilorin Teaching Hospital, which is a tertiary health institution. Subjects: The study included seventeen (17) Patients above the age of 18 years who presented with goiter and had elective thyroidectomy done within the study period. Outcome Measures/Results: The 17 patients represented 65% of all those who underwent thyroidectomy in our hospital within the study period. There were 15 females and 2 males, giving a female to male ratio of 7.5:1. The median age of the patients was 44 (range 20-80) years. Types of goiter included 13 simple multinodular or nodular goiters, 3 diffuse toxic goiters and 1 malignant goiter. Sixteen (16) patients had subtotal thyroidectomy, while one had total thyroidectomy. Varying degrees of pressure symptoms during mobilization of the gland, and postural aches were some of the intra-operative problems encountered. These problems were described by the patients as tolerable. Fifteen (88%) of the patients found the anaesthesia satisfactory and would not mind recommending or having the same anaesthetic technique for similar procedure. Two (12%) of the patients expressed dissatisfaction with the anaesthesia and would not want it for similar procedure. In one of the two, the surgery was completed under general anaesthesia with endotracheal intubation when the block was found to be ineffective. The second patient became extremely apprehensive during surgery, although she denied experiencing any significant pain and refused conversion to general anaesthesia. Conclusion: Bilateral superficial cervical plexus block is a useful anaesthetic option for thyroidectomy in temperamentally suited patients. Although the number was small, we can conclude that the block is feasible, safe, effective and easy to perform. It was acceptable to our patients.