To Compare the Incidence of Postoperative Pain and Nausea/Vomiting in Thyroidectomy Patients Undergoing General Anaesthesia with Or Without USG Guided B/L Superficial Cervical Plexus Block

Background: Patient undergoing thyroidectomy experience severe post-operative pain and nausea/vomiting, Incidence of PONV is around 60%. Volatile anaesthetics, nitrous oxide, opioids and even post-operative pain have been found to increase the incidence of PONV. So, a combination of regional anaesthesia with general anaesthesia will provide prolonged postoperative analgesia and reduce opioid requirements and also decrease PONV. Ultrasound guided superficial cervical plexus block is a simpler and safer technique in alleviating postoperative pain and nausea/vomiting.

AIM To test the hypothesis that adjunct B/L Superficial cervical plexus block with general anaesthesia in patients undergoing thyroidectomy might reduce the incidence of PONV and postoperative pain score

Materials And Methods For the superficial cervical plexus block, the injection is made between the investing layer of the deep cervical fascia and the prevertebral fascia. The superficial cervical plexus block results in anaesthesia of the skin of the anterolateral neck and the preauricular and retro auricular areas and immediately inferior to the clavicle on the chest wall.Since the cervical plexus is made up of purely sensory nerves high concentrations of local anaesthetic is not usually required, so we use Bupivacaine 0.25% as a local anaesthetic of choice. Postoperatively Visual Analog Scale (VAS) is used to assess postoperative pain and APFELS SCORE to assess nausea/vomiting.

Results Patients receiving ultrasound-guided bilateral SCPB (Group B) had significantly lower postoperative pain scores and required fewer rescue analgesics than those receiving general anaesthesia alone (Group A). The mean rescue analgesic requirement was 51.72 ± 23.00 in Group A compared with 19.00 ± 7.82 in Group B (p = 0.005), demonstrating the effectiveness of SCPB in postoperative pain control following thyroidectomy.The SCPB group also showed a significant reduction in postoperative nausea and vomiting. Within the first 4 hours postoperatively, 52.5% of patients in Group A experienced nausea and vomiting, compared with only 16.7% in Group B (p = 0.012), resulting in reduced use of rescue antiemetics.

Conclusion Ultrasound-guided SCPB is a promising technique for reducing postoperative pain and nausea/vomiting control in thyroidectomy patients, while also reducing opioid consumption. It enhances pain relief and decreases the need for rescue analgesics and antiemetics. Addition of SCPB along with GA can help with better recovery by minimizing opioid-related side effects, improving patient outcomes, and increasing patient satisfaction