Thyroidectomy under Loco-regional anaesthesia with Monitored Anaesthesia Care

Abstract

Background: The majority of thyroid surgery is currently performed under general anaesthesia (GA); however, most patients suffer feelings of lethargy and drowsiness after emergence from general anaesthesia, postoperative pain and difficulty accessing voice changes due to recurrent laryngeal nerve damage or nerve compression. Several recent studies show that thyroidectomy can be safely performed under loco-regional anaesthesia with monitored anaesthesia care(MAC) conducted by anaesthesiologists.This technique can avoid airway manipulations like tracheal intubation and general anaesthetics. Objectives:The main aim of this study is to evaluate the feasibility of bilateral superficial cervical plexus blocks with local infiltration under monitored anaesthesia care for thyroidectomy without patient or surgeon discomfort.Methods;This is a hospital-based interventional descriptive study. After applying exclusion criteria, eleven patients underwent thyroidectomy at No. (2) Military Hospital (500-Bedded), Yangon, Myanmar, from May 2023 to May 2024. Thyroidectomies were done by a single surgeon. Demographic data, intraoperative 0utcome-such as patient discomfort (pain, coughing, movement), voice changes, conversion to general anaesthesia, and patient and surgeon satisfaction with this anaesthetic technique were recorded and analysed . Results: There were eleven patients (10 females, 1 male) with a mean age of the patient was 44 years (the youngest was 20 and the oldest was 80years). The types of diseases included one malignancy, two diffuse goiters, eight simple multinodular goiters. The surgical procedure consisted of ten subtotal thyroidectomies and one total thyroidectomy. All patients tolerated varying degrees of discomfort during the operation, and no one needed a conversion to general anaesthesia. One patient suffered transient hoarseness ofvoice, which was relieved by anti-inflammatory drugs within two days. Surgeon satisfaction was high (10 satisfied,1 so-so), and most patients were satisfied (9satisfied, 2 so-so).

Conclusion: Thyroidectomy under bilateral superficial cervical plexus block with monitored anaesthesia care is feasible, safe, and cost-effective. It allows real-time voice monitoring, avoids airway instrumentation, and shortens hospital stay. Moreover, it avoids the usage of volatile anesthetics, leading to reduced environmental pollution.