Thyroidectomy Using Local Anesthesia: A Report of 1,025 Cases over 16 Years

General or Local Anaesthesia in One-Day Thyroid Surgery-Does It Matter?

“…After that time, with the development of newer and safer anesthetic techniques, and with the modern intravenous anaesthetic agents like propofol, midazolam, and fentanyl, thyroidectomy was performed exclusively under general anaesthesia and in inpatient settings. The current trend now favors minimally invasive thyroid surgery techniques, ambulatory approach, shortening of hospital stay and once more utilizes preferably Local anaesthesia + Monitored Anaesthesia Care (LA + MAC) (1)(2)(3)(4)(5)(6). However, the complexity of the procedure may vary from excision of a single nodule to removal of the entire thyroid gland with lymph dissection to treat cancer, or extirpation of a retrosternal goitre to relieve tracheal compression.…”

Thyroidectomy Under Local Anesthesia

“…Spankenebel et al [13] reported a series of 1,025 cases of thyroidectomy using local anesthesia over a 16-year period. The authors noted hospital stay was shorter, and the incidence of postoperative complications was observed to be similar to thyroidectomy under general anesthesia.…”

“…Other contraindications include large goiter, previous neck surgery, sleep apnea, coagulopathy, severe claustrophobia or anxiety, morbid obesity, preoperative recurrent laryngeal nerve paralysis, retro-esophageal or retro-tracheal goiter, need for sternotomy, concomitant cervical lymphadenopathy, known or suspected locallyinvasive cancer, patient preference for general anesthesia, and allergy to local anesthesia. However, some studies have revealed that indications may be extended with increased surgeon and anesthesiologist experience [13]. The surgeon and anesthesiologist must also be prepared to convert to general anesthesia at any time during the procedure, and to do so in a controlled and safe fashion.…”

“…Alone or in combination, lidocaine and bupivacaine are excellent choices; such combinations of short and longer-acting anesthetic agents can be supplemented with epinephrine (1:100,000 or 1:200,000) to prolong the duration of the anesthetic [13,15,17]. The cervical nerve block may be executed by the anesthesiologist or surgeon before the patient enters the operating room, or by the surgeon just before making the incision.…”

“…Subsequently, this series of patients grew to well over 1,000 patients. Spanknebel et al [13] reported 3.3 % conversion to general anesthesia, 1 % incidence of recurrent laryngeal nerve injury (unrelated to anesthetic technique), 0.5 % incidence of postoperative wound hematomas requiring reoperation, and one case of permanent hypoparathyroidism.…”