Awake thyroidectomy

Abstract

Objective In this article, we present a series of 28 patients who underwent thyroid surgery using local anesthesia. We describe our technique, report outcomes, and assess how well the procedure was tolerated from a patient perspective. Methods Three surgeons performed awake thyroidectomies and recorded data, including the patient's age and gender, surgery being performed, operative time, weight of the surgical specimen, quantity and type of local anesthetic used, additional medications, patient‐reported pain assessment, and any complications. Results Twenty‐seven of 28 patients (96%) successfully underwent awake thyroidectomy. One patient had to be converted to general anesthesia due to airway concerns. There were no complications; however, one patient had a panic attack. Based on a 0 to 10 scaled pain score, the average amount of pain reported was 3.4. The amount of pain the patient reported was significantly dependent on the amount of experience the operating surgeon had with this technique. Seventy‐one percent of patients tolerated surgery with local anesthesia only and did not require additional medications. Conclusion Awake thyroidectomy is a well‐tolerated and safe procedure in appropriately selected patients, with many potential benefits over general anesthesia. In most cases, only local anesthesia is required. Increased experience with this technique may be associated with increased patient comfort. Level of Evidence 4 Laryngoscope, 130:685–690, 2020

Climate Change and Otolaryngology–Head and Neck Surgery

“…This staggering difference is, to a large part, achieved by cutting waste. At MAMC, essentially nothing disposable is used; health care bloat (the ratio of physicians to other health care workers/administrators) is low; facility expenditures are minimized; and in the case of thyroid surgery, even general anesthesia is often eliminated by performing surgery with local anesthesia alone 10 . Ultimately, the same outcome is achieved at less than 2% of the cost and with far less waste.…”

Euthyroidectomy under local versus general anesthesia in health camp settings in Uganda: a protocol for randomized prospective equivalence single-blind controlled trial

“…Albert Theodor Billroth was the first surgeon to popularize thyroid surgery, which encompassed primarily drainage of the thyroid cysts, although with concerns of post-operative pain and high levels of recurrence [ 7 ]. Subsequently, thyroidectomy was for years conventionally performed under regional local anesthesia (LA) resulting in loss of sensation and pain in a localized part of the body [ 8 – 10 ] with some series reporting favorable outcomes on over 20,000 patients as of 1990 [ 9 , 11 ].…”

Aphonia Following Bilateral Cervical Plexus Blocks for an Awake Hemithyroidectomy: A Case Report

“…However, in selected cases, awake thyroidectomies with cervical nerve blocks are well described in the literature, which can attenuate postoperative pain, especially in the first few hours. 1 Additional benefits include avoidance of airway manipulation, less postoperative nausea and vomiting, and early recovery with a reduced hospital stay. A cervical plexus block (CPB) has effectively been used as the sole modality for neck surgeries, predominantly for carotid endarterectomy and thyroidectomy.…”