Impact of an Intermediate Cervical Plexus Block on Per and Post Operative Opioids Consumption in Patients Scheduled for Total Thyroidectomy under General Anaesthesia: a Randomized Study

Background: Ultrasound-guided intermediate cervical plexus block (ICB) recently described seems to be promising, we aim to clarify the contribution of this block on per-operative reduction of opioids consumption during thyroidectomy under general anesthesia and to determine post-operative morphine requirement, the resulting adverse effects and patient satisfaction. Methods: seventy patients were included in a prospective observer-blinded trial and randomized to be allocated to: Group 1 (GP1): Bilateral echo-guided ICB by 10 ml of isobaric Bupivacaine (0.25%). (35 patients) realized 10 minutes before general anesthesia. Group 2 (GP2): Control (35 patients). Total dose of Remifentanil is calculated upon awakening, postoperative pain is determined by visual analogic scale from 0 to 10 (VAS) statements at: H0, H2, H4, H6, H12 and H24. Whenever EVA ≥ 4, morphine titration was administered; total dose consumption, side effects and satisfaction are noted at the end of the protocol. Results: Per operative opioids consumption was significantly decreased by more than 38% for GP1. The post-operative morphine titration request in GP1 was noted for 10 patients VS 21 in GP2. We noted nauseas and vomiting for 9/29 patients in GP1 against 13/31 in GP2. The VAS at H1 and after H12, was significant statistically higher for GP2.For GP1, 22/29 patients (75%) were satisfied VS 13/31 (42%) for GP2. Conclusion: ICB for total thyroidectomy under general anesthesia allows per and post operative opioids decreasing, and my provides a better analgesia and reduces adverse events. This technique seems to leads for a better patient satisfaction.