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Anesth Analg 2007; 105:1160-1163
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000280443.03867.12
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ANALGESIA

A Prospective, Randomized Comparison Between Combined (Deep and Superficial) and Superficial Cervical Plexus Block with Levobupivacaine for Minimally Invasive Parathyroidectomy

Tatjana Stopar Pintaric, MD, MSc*, Marko Hocevar, MD, PhD{dagger}, Simona Jereb, MD{ddagger}, Andrea Casati, MD§, and Vesna Novak Jankovic, MD, PhD||

From the Departments of *Anaesthesiology, {dagger}Surgery, {ddagger}Radiology, Institute of Oncology, Ljubljana, Slovenia; §Department of Anaesthesiology, University of Parma, Parma, Italy; and ||Department of Anaesthesiology and Intensive Therapy, Clinical Center Ljubljana, Ljubljana, Slovenia.

Address correspondence and reprint requests to Dr. Tatjana Stopar Pintaric, Department of Anesthesiology, Institute of Oncology, Zaloska 2, 1000 Ljubljana, Slovenia. Address e-mail to tstopar{at}onko-i.si.

Abstract

BACKGROUND: Minimally invasive parathyroidectomy (MIP) can be performed under cervical plexus block (CPB). Superficial CPB has been reported to be easier to perform with similar efficacy and less anesthesia-related complications than combined deep and superficial CPB. In this study, we compared the efficacy of superficial and combined (deep and superficial) CPB in patients undergoing MIP.

METHODS: Forty-two patients with primary hyperparathyroidism due to a solitary adenoma were randomized to receive either a superficial (group superficial, n = 20) or a combined deep and superficial CPB (group combined, n = 22) using 0.35 mL/kg of 0.5% levobupivacaine. The primary end-point was the amount of supplemental fentanyl required to complete surgery.

RESULTS: There were no differences in onset of block, pain scores during surgery, or time to first analgesic request between groups. Fentanyl consumption was similar in both groups, i.e., 50 (0–200) µg in group superficial and 50 (0–100) µg in group combined (P = 0.60). Six patients [1 in group superficial (5%) and 5 in group combined (22.7%)] were converted to general anesthesia for surgically required bilateral neck dissection (P = 0.18). General anesthesia for block failure was reported in three superficial (15%) and two combined group patients (9%) (P = 0.99). In group combined, only one patient (4.5%) showed diaphragmatic paresis after the block (P = 0.99).

CONCLUSION: Superficial CPB is an alternative to combined block for MIP.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.