Bilateral Superficial Cervical Plexus Block Alone or Combined with Bilateral Deep Cervical Plexus Block for Pain Management After Thyroid Surgery

Background and Objectives: Patients undergoing thyroid surgery need postoperative pain management. Bilateral superficial cervical plexus block (BSCBs) has been shown to improve postoperative analgesia. The objective of this study was to assess its analgesic efficacy in the first 24 hours after thyroid surgery alone and when combined with bilateral deep cervical plexus block (BDCBs). Methods: We performed a prospective randomized and controlled study that compared 3 equal parallel groups, 12 patients each: Group A, received (BSCBs) before surgery and under general anaesthesia with 10 ml of bupivacaine 0.5% and epinephrine 1:200.000 in each side. Group B received (BSCBs) as in group A with (BDCBs) with 5 ml bupivacaine 0.5 % and epinephrine 1:200,000 at the level of C3. Group C: received general anaesthesia without any block. Postoperative pain was assessed by the use of a 0-10 numeric rating scale. All patients received paracetamol every 6 hours. Morphine was administered following a standardized protocol if the numeric rating scales was 4 or higher. The main outcome variables were the proportion of patients given morphine during the 24 hours postoperatively, pain intensity scores, and total morphine consumption. Results: There was no significant difference among the 3 groups as regards their demographic data. Both groups A&B were significantly superior to the controlled group C as regards percentage of patient required morphine, pain scores and postoperative morphine consumption. In comparison between groups A&B, there was no significant difference between the 2 groups as regards the main outcome variables. (P < 0.05). Conclusion: Bilateral deep cervical plexus block does not add significant analgesic efficacy or has a narcotic saving strategy when combined with bilateral superficial cervical plexus block for pain control after thyroid surgery.