Comparative Study of Pre-Emptive Analgesia by Bilateral Superficial Cervical Plexus Block Induced by Levobupivacaine vs Ropivacaine in Thyroid Surgeries

Abstract

Background: Thyroid surgery is the most common endocrine surgery done over the world, which requires analgesia due to mild to moderate pain. It is commonly done under general anesthesia and locoregional techniques like local infiltration along incision line and regional blocks such as superficial cervical plexus block. Bilateral superficial cervical plexus block (BSCPB) is preferred, as it is simple and efficient to counteract pain, stress response caused during perioperative period. The study was done to compare depth of analgesia of levobupivacaine and ropivacaine using ultrasound guided bilateral superficial cervical plexus block in patients undergoing thyroid surgeries under general anesthesia.

Methods: 60 consenting patients were included in the study and divided into two groups. Group A received BSCPB with levobupivacaine 0.25% (n = 30) and group B received ropivacaine 0.25% (n = 30), in this double blind, randomised study. Demographic profile, hemodynamic parameters, total duration of analgesia with total requirement of fentanyl in intraoperative period were evaluated. Post operatively, visual analogue score (VAS) was seen and tramadol was given as rescue analgesic drug whenever VAS ≥ 4.

Results: Duration of analgesia was significantly higher in the levobupivacaine group (480 mins (450-540)) compared to ropivacaine group (330 mins (240-360)). There was statistical difference in the number of patients requiring intraoperative fentanyl (p value <0.05). In levobupivacaine group, 9 (30.0 %) patients required fentanyl and in ropivacaine group, 13 (43.33%) patients required fentanyl. Levobupivacaine group had significantly lower VAS score compared to ropivacaine group.

Conclusion: Pre-emptive analgesia by BSCPB using levobupivacaine has better analgesic efficacy in comparison to ropivacaine in patients undergoing thyroid surgeries under general anesthesia. Bilateral superficial cervical plexus block is an effective, safe and useful method to manage pain in patients undergoing thyroid surgeries.