The Efficacy of Intermediate Cervical Plexus Block Versus Cutaneous and Thyroid Capsular Blocks
Condition: Thyroid Surgery
MeSH terms: Thyroid Diseases
Study type: Interventional

Summary: 
      Thyroid gland surgery is one of the most commonly performed operations for either benign or
      malignant pathologies Pain related to thyroid surgery is of moderate intensity .which may be
      treated with NSAIDs or opioids. However, Opioids have many well-known undesirable effects,
      including postoperative nausea and vomiting, which are frequent after this type of procedure.
    

Detailed description: 
      Regional techniques of anesthesia may help to decrease post-operative pain and reduce
      systemic analgesic requirement. Classically, the cervical plexus is considered to have two
      distributions, the superficial cutaneous and the deep motor nerves.

      Anatomically, the thyroid gland has an inner true capsule which is thin and adheres closely
      to the thyroidal tissue [Fancy et al., 2010]. External to this is a false capsule formed by
      the middle layer of the deep cervical fascia, which splits anterolaterally to ensheathe the
      thyroid gland, thus forming the thyroid sheath [Bliss et al., 2000]. In this fashion, the
      potential space called the capsule-sheath space is formed. It contains also loose connective
      tissue, blood vessels, nerves and parathyroid gland. Anesthetic deposited in this space would
      block the surface of thyroid gland and permeate directly into the parenchyma producing
      effective local anesthesia for thyroid surgical procedures. It is supposed also to involve
      autonomic nerve block of the thyroid gland [Fliers et al., 2010]. Additionally, a
      subcutaneous injection along the sternocleidomastoid muscle (SCM) would also enhance
      effective local anesthesia for the initial skin incision and further contribute to a more
      ideal working environment for the surgeon. Therefore, anesthetic technique termed
      ultrasound-guided capsule-sheath space block (CSSB) combined with anterior cervical cutaneous
      nerves block (CCNB) for thyroidectomy is done [Wang et al., 2015] .

      Our hypothesis is that a combination of simple dual techniques including superficial
      cutaneous block to provide sensory blockade, and surgeon mediated capsular block may afford
      autonomic thyroid blockade. In comparison, ultrasound guided intermediate cervical plexus
      block may provide these blocks but using a machine and deep penetration possibly involving
      unwanted blocks for phrenic and recurrent laryngeal nerves. So, if the simple safe technique
      can provide the same intra and postoperative anesthetic conditions it will be preferred.
    

Intervention name(s): Capsule and cutaneous blocks; US-intermediate cervical plexus block
Intervention type(s): Procedure; Procedure
Intervention description(s): 7.5 mL of 0.5% bupivacaine + Epinephrine 5 ug/ ml for both blocks once before surgery per side; 15 mL of 0.5% bupivacaine + Epinephrine 5 ug/ ml once before surgery per side.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Other