Objective: Uses of simple analgesics were found insufficient to manage pain after thyroid surgery. We hypothesized that using bilateral superficial cervical plexus block (BSCPB) might influence the pattern of immediate postoperative pain and analgesic consumption. The general objective of the study was to assess the analgesic efficacy of bilateral superficial plexus block for thyroid surgery under general anesthesia. Results: A total of 74 willing patients involved. Half of them had received BSCPB with 10 ml of 0.25% bupivacaine just before induction and the remaining half did not. Postoperatively, patients were assessed at immediate, 2nd, 6th, 12th and 24th h. At all endpoints, NRS-11 scores for pain were significantly lower in the block group. The time to first analgesic requirement was significantly longer 132.3 ± 71.5 min vs 71.4 ± 60.0 min, p = 0.009. Opioid and total analgesic consumption were reduced by BSCPB in the first 24 postoperative hours. There was low but non-significant rate of PONV in the block group. No clinically important adverse event was noted related to BSCPB.
Background:
Following surgery, neuromuscular paralysis is no longer needed, its action could be quickly and effectively terminated. However, evidences shown that NMBAs often continues in the PACU, even after the administration of acetylcholinesterase inhibitor. Hence, stratifying risks of patients and developing evidence-based guidelines are required by rationalizing residual neuromuscular block preventive strategies in resource limiting setup.
Methods:
Preferred reporting items for systematic reviews and meta-analyses protocol was used to conduct this review. PubMed, Google Scholar, and Cochrane Library data bases were used to find evidences that helps to draw recommendations and conclusions.
Discussion:
The incidence of residual neuromuscular block is high in aged, female, and hypothermic patients. Full recovery of neuromuscular block may require 15–30 min after administration of anticholinesterase.
Conclusions:
Undetected neuromuscular block following the administration of NMBAs is still a common problem in today's anesthesia care. A residual neuromuscular block is a preventable anesthetic complication by application of simple measures like the timing of reversal, appropriate assessment of patient and surgery specific usage of NMBAs.
Highlights:
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