The benefits of preincision ropivacaine infiltration for reducing postoperative pain after robotic bilateral axillo-breast approach thyroidectomy: a prospective, randomized, double-blind, placebo-controlled study

Abstract

PurposeThe aim of this study was to evaluate the effects of preoperative ropivacaine infiltration in patients undergoing robotic thyroidectomy using the bilateral axillary breast approach method.MethodsUsing a randomized, double-blind study design, 34 consecutive female patients who underwent robotic thyroidectomy were randomly assigned to receive local infiltration to the skin flap site using either only 0.9% saline solution, 3 mL/kg (group C, n = 17) or 0.1% ropivacaine with saline, 3 mg/kg (group L, n = 17). Local anesthetic was administered prior to skin incision after the induction of general anesthesia. Postoperative pain was rated at 2, 6, 18, 30, 42, and 66 hours postoperatively by visual analogue scale (VAS) score. The bottom hit counts (BHC) from patient controlled analgesia and fentanyl consumption were evaluated. CRP levels, mean blood pressure (BP), and heart rate (HR) were also evaluated.ResultsVAS pain scores were significantly lower in group L than in group C from 2 to 42 hours (P < 0.05). Fentanyl use for analgesia and BHC were also significantly lower in group L compared with group C during the first postoperative 6 and 2 hours, respectively (P < 0.05). The total consumption of fentanyl was significantly lower in group L than in group C (P = 0.009). No significant differences were noted for baseline, postoperative mean BP, or HR.ConclusionPreoperative infiltration using ropivacaine with saline to all flap sites is a safe and effective method for reducing postoperative pain and postoperative fentanyl consumption in patients with robotic thyroidectomy.

Preoperative flap-site injection with ropivacaine and epinephrine in BABA robotic and endoscopic thyroidectomy safely reduces postoperative pain

“…[13,22] We also chose ropivacaine as our local anesthetic because of its long block duration, lower toxicity than levobupivacaine, and greater safety. [23] Its low lipophilic profile also means that it is unlikely to induce cardio- and central nervous system toxicity.…”

Bilateral Axillo-Breast Approach Robotic Thyroidectomy: Introduction and Update

“…This "hydrodissection" technique is used to create a saline pocket in the subplatysmal layer to reduce bleeding in the flap area and facilitate subsequent dissection. Additionally, Kang et al previously reported that infiltration of the flap sites with a ropivacaine-saline solution (100 cc normal saline mixed with 3 mg/kg 0.1% ropivacaine) is a safe and effective method for reducing postoperative pain and postoperative analgesic need [14].…”

“…Because previous studies have used different assessment scales, it is not possible to provide a standardized comparison of postoperative pain by meta-analyses; nevertheless, the overall evidence suggests that RoT and OT achieve similar results in terms of postoperative pain. Table 6 shows the results of three prospective randomized controlled trials (including 108, 55, and 34 subjects, respectively) that attempted to reduce postoperative pain after BABA RoT [14,24,51]. In all three studies, the preoperative and postoperative instillation of analgesics (ropivacaine or levobupivacaine spray) to the flap site during BABA RoT reduced postoperative pain and the need for analgesics compared with the OT group.…”

Robotic thyroidectomy and cervical neck dissection for thyroid cancer

“…Approximately 100 cc of normal saline mixed with 3 mg/kg of 0.1% ropivacaine is then used to infiltrate the subcutaneous or subplatysmal layer of the flap dissection area with a 23-gauge spinal needle. We previously reported that infiltration of the flap sites with a ropivacaine-saline solution is a safe and effective method for reducing postoperative pain and postoperative analgesic consumption (32). Because the upper and mid-neck area flap is dissected sharply with robotic scissors, causing little pain, the pre-incisional injection is omitted in this area.…”

“…First, this step influences the surgical stress and post-operative pain. From our prospective, randomized, and controlled trial, we learned that flap site pain, especially in the infra-clavicular and anterior chest area, was the most important pain after robot thyroid surgery (32). Vigorous blunt dissection with a vascular tunneler may cause serious bleeding and postoperative pain.…”