Multimodal Analgesia with Local Wound Infiltration and Intravenous Parecoxib for Thyroidectomy

Abstract

Background and objective: Adequate postoperative pain control is an important component to enhance recovery. Multimodal analgesia with various pain control techniques has been widely used to alleviate postoperative pain. The use of either wound infiltration or a superficial cervical plexus block has been reported to be effective for pain management after thyroid surgery. The present study evaluated the effect of multimodal analgesia using lidocaine wound infiltration combined with intravenous parecoxib for patients monitored after thyroidectomy. Materials and Methods: A total of 101 patients with a multimodal analgesia protocol being monitored after thyroidectomy were enrolled. After the induction of anesthesia, multimodal analgesia was performed through wound infiltration of 1% lidocaine and epinephrine at a ratio of 1:200,000 (5 μg/mL) combined 40 mg intravenous parecoxib before skin excision. Patients were divided into two groups for this retrospective analysis based on the injection dose of lidocaine they received. Patients in Group I (the control, n = 52) received a 5 mL injection solution, while those in Group II (the study, n = 49) received a 10 mL dosage in a time-sequential manner, in accordance with a previous clinical trial. The primary outcome was measuring postoperative pain intensity at rest, as well as during motion and coughing, which was measured at the postoperative anesthetic care unit (PACU) and on the first day after the operation (POD 1) in the ward. Pain intensity was assessed using a numerical rating scale (NRS). The secondary outcomes were postoperative adverse events including anesthetic-related side effects, as well as airway and pulmonary complications. Results: Most of the patients reported no pain or mild pain during the observation period. The patients in Group II had a lower pain intensity during motion than Group I (NRS 1.47 ± 0.89 vs. 1.85 ± 0.96, p = 0.043) when measured at the postoperative anesthetic care unit. Pain intensity during coughing was also significantly lower in the study group than in the control group (NRS 1.61 ± 0.95 vs. 1.96 ± 0.79, p = 0.049) when measured at the postoperative anesthetic care unit. There were no severe adverse events in either of the groups. Only one patient (1.9%) in Group I experienced temporary vocal palsy. Conclusions: The use of lidocaine with an equal volume of intravenous parecoxib provided comparable analgesia with minimal adverse events when monitoring thyroidectomy.

Local Wound Infiltration for Thyroidectomized Patients in the Era of Multimodal Analgesia

“…Apart from the fact that no difference regarding age between groups existed, no further age-subgroup analysis was conducted [ 3 , 4 , 5 , 6 , 10 , 11 , 16 , 17 , 18 , 19 ]. An ASA status of I or II was required when participating in the trial [ 5 , 8 , 9 , 10 , 13 , 14 , 16 , 17 , 18 , 19 ], although some authors include patients with a status of III [ 6 , 11 , 20 ]. Long-term analgesic, corticosteroid or sedative medication or the use of analgesics 7 days prior to the procedure was prohibited [ 7 , 9 , 10 , 11 , 13 , 14 , 15 , 16 , 17 , 18 ].…”

“…TSH, cortisol, renin and ACTH plasma levels, although elevated, show no difference between the groups [ 5 ]. The efficacy of lidocaine as a part of a multimodal protocol though, was also suggested by Gau et al The authors also showed that the higher volume of lidocaine was superior in terms of pain score on the day of operation and even during the first postoperative week [ 20 ].…”

“…Except for one, the majority of authors agree that thyroidectomy wound infiltration consists of an easy-to-reproduce technique operated by the surgeon himself, while it elongates the time frame until rescue analgesia. Both the efficacy and the duration of the method depend on surgical incision length, as well as the topical agent used [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Miu et al, could not prove any significant analgesic benefit with ropivacaine infiltration at the end of thyroid surgery [ 11 ].…”

“…Table 1 summarizes the reported trials. All of them were prospective, randomized trials except for one observational research based on a prior clinical trial [ 20 ]. Each article was carefully studied and a database was created, emphasizing the investigated preparation, the infiltration timing, the postoperative VAS score and the analgesic requirement, as well as the reduction in opioid consumption.…”