Vol 18, No 3 (2024)

The number of thyroid surgeries is increasing annually. The choice of anesthetic approach influences the speed and quality of postoperative recovery and affects the risk of complications. This review presents data from clinical studies and meta-analyses regarding the impact of various anesthesia methods in thyroid surgery on surgical stress response, hormonal status, and complication risk. The findings indicate that regional anesthesia techniques help to reduce postoperative pain intensity, nausea and vomiting, and the incidence of chronic postoperative pain syndrome. Incorporating regional anesthesia techniques into enhanced recovery after surgery protocols for thyroid surgery helps reduce hospital stay duration and treatment costs. The superficial cervical plexus block is a well-studied, simple, and safe technique, while the intermediate cervical plexus block is less studied but considered safe. The deep cervical plexus block is associated with a higher risk of serious complications. Advancements in ultrasound-guided anesthesia have enabled the use of previously inaccessible regional techniques. Potentially beneficial methods for thyroid surgery include pericapsular block and block of ligament of Berry. Further research is required to evaluate the efficacy and safety of these methods.

Selecting an appropriate method of regional anesthesia for clavicle fracture surgery has become increasingly relevant due to a continued growth in contraindications for traditional upper limb nerve blocks. Factors such as chronic pulmonary dysfunction in post-COVID-19 patients, an increasing number of patients with severe respiratory failure from chronic obstructive lung disease, and upper limb injury-related impairments to lung function on the affected side have raised concerns that regional anesthesia might pose greater risks than benefits. We searched for publications in various electronic databases and libraries including PubMed, MEDLINE, and EMBASE and others. The search yielded 904 sources, and this review includes data from 26 studies involving 3,391 patients who received one or another method of regional anesthesia and analgesia. Additional 29 references were analyzed to substantiate the relevance of the study. The review includes articles describing any methods of regional anesthesia used in clavicle surgeries for both adults and children, as well as articles on complications and side effects of these methods. The aim of the review was to search for methods of regional anesthesia for the surgical treatment of clavicle fractures, based on the analysis of modern literature. The literature review provided insights into the characteristics of traditional methods of regional anesthesia and introduced new techniques that can improve patient comfort and safety during clavicle surgery.

BACKGROUND. Surgeries involving the anterior neck (thyroidectomy, carotidectomy, plastic surgery, etc.) are widespread in Russia. Developing effective anesthesiological strategies for these procedures is a key goal in modern anesthesiology. The introduction of combined regional anesthesia techniques into surgical practice may help to minimize postoperative complications including severe pain syndrome, postoperative nausea, and vomiting.

AIM. To compare the effectiveness of combined anesthesia (general + regional) with general anesthesia alone in thyroid and parathyroid gland surgeries.

MATERIALS AND METHODS. In a prospective randomized study, 60 patients undergoing thyroid and parathyroid gland surgery were divided into two groups. Group 1 received general anesthesia combined with internal fascia of the neck block, bilateral block of the superficial branches of the cervical plexus, and block of ligament of Berry under ultrasound guidance. Group 2 received only general anesthesia. Hemodynamic profiles, plasma cortisol levels, fentanyl consumption, postoperative pain intensity, need for additional analgesia, and recovery time were evaluated.

RESULTS. Compared to the group receiving only general anesthesia, patients receiving combined (general + regional) anesthesia showed a decrease in fentanyl consumption (p <0.0001), lower plasma cortisol levels 12 hours post-extubation (p =0.0439), a reduction in median pain intensity after tracheal extubation 3 and 12 hours after surgery (p =0.0190, p <0.0001), as well as a twofold reduction in time from the end of surgery to extubation (p =0.0001). Additionally, patients in the combined anesthesia group had higher scores on the Aldrete recovery scale, indicating a quicker readiness for transfer to the recovery ward (p =0.0114).

CONCLUSION. The study demonstrated the effectiveness and safety of combined anesthesia in thyroid and parathyroid surgery, which provides adequate anesthetic protection for patients.

BACKGROUND: In the protocols of rapid recovery after surgery, it is recommended to avoid long-term administration and/ or high doses of opioids in order to reduce the severity of their adverse reactions in the postoperative period. In this regard, opioid-sparing anesthesia (OSA) may become a promising approach to the treatment of cancer patients.

AIM: To evaluate the effectiveness of multimodal OSA in the scheme “dexmedetomidine + ketamine (in subanesthetic doses) + lidocaine (intravenous infusion)” in pediatric oncosurgery.

MATERIALS AND METHODS: A single-center prospective randomized study involved 40 children aged 12 to 18 years. Patients were divided into 2 groups depending on the method of anesthesia: in group I (n =20), combined endotracheal anesthesia with opioids was performed, in group II (n =20) — multimodal OCA based on intravenous infusion of lidocaine, dexmedetomidine and subanesthetic doses of ketamine. The patients underwent extended operations in the head and neck area in the volume of thyroidectomy with fascial-sheath lymph dissection and excision of the central tissue of the neck from 2 sides.

RESULTS: With stable intraoperative hemodynamic parameters, the median total intraoperative need for analgesics in group II was: for lidocaine — 351 (289.6; 418.5) mg (which is 1.75 mg/kg per hour), for dexmedetomidine — 88.2 (38.5; 119.7) µ g, for ketamine — 21.6 (17.4; 27.3) mg. In group I, the median total intraoperative need for fentanyl was 273.7 (406; 240.9) µ g. In addition, in group I, the median amount required for postoperative analgesia of the synthetic opioid analgesic tramadol was 419 (365.6; 479) mg (which is 7.8 mg/kg; p =0.01). In group II, the median amount of lidocaine required for postoperative analgesia (1 mg/kg per hour) turned out to be 1377.3 (735.7; 1894) mg, while additional tramadol administration at a dose of 57.3 (28.5; 107.7) mg was required in only 7 (35%) patients.

CONCLUSION: Multimodal OSA based on dexmedetomidine, lidocaine, ketamine and sevoflurane is an effective and safe method of anesthesia in children from 12 to 18 years old, which is not inferior to opioid analgesics in the treatment of perioperative pain during surgical interventions on the thyroid and parathyroid glands in cancer patients, and also reduces the number of adverse reactions characteristic of opioids.