Source: DGNews  |  Posted 5 years ago

By Crystal Phend

SAN DIEGO, C.A. -- March 27, 2006 -- Cervical block with local anesthesia appears to significantly reduce postoperative pain, nausea and vomiting compared to general anesthesia in patients who undergo minimally invasive parathyroidectomy, according to a study presented here at the Society of Surgical Oncology?s annual meeting (SSO).

The advantages of local cervical block anesthesia versus general anesthesia for these focused procedures had not been clearly demonstrated before, said lead author Michael J. Black, MD, general surgery resident, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States.

In the retrospective study, Dr. Black and co-investigators enrolled 177 patients with primary hyperparathyroidism and offered them either local cervical block or general anesthesia prior to minimally invasive parathyroidectomy. Forty-one percent chose local cervical block while 59% selected general anesthesia.

Visual analog pain scale scores (VAS) were assessed, but the primary endpoints were intravenous narcotic use, use of antiemetics medication, and incidence of nausea and vomiting, and pain.

Treatment groups were similar except that the local anesthesia group was significantly older on average (64 years versus 57) than the general anesthesia group. Cure rates were about 100% in both groups.

Complications occurred in 4% of the local anesthesia group and 2% of the general anesthesia group, which was not a significant difference. Length of hospital stay was very similar as well, 0.4 days compared to 0.3 days for general anesthesia.

Local cervical block resulted in significantly less pain. The overall mean VAS score was 1.9 for local and 3.1 for general anesthesia, with 10 being the highest possible score. Postoperative pain peaked at 5 on the same VAS scale for general anesthesia patients and about 3 for local anesthesia patients.

Antiemetic use was more than 4 times higher in the general anesthesia group on average (1.7 versus 0.4). Mean intravenous narcotic use was significantly higher in the general anesthesia group, at about 23 morphine equivalent units compared to about 12 for the local cervical block group.

Both nausea and vomiting occurred significantly more frequently in the general anesthesia group (about 50% versus about 15% and about 24% versus about 6%, respectively).

?The choice of anesthesia did not affect surgical cure rate, morbidity, or length of stay,? Dr. Black said. However, he noted, there may be some benefit to using local anesthesia in addition to avoiding the potential complications of general anesthesia.

Randomized controlled studies are needed to definitively compare different types of anesthesia for parathyroidectomy, Dr. Black said, but this study?s findings still give patients some information that could help them select among various options.

[Presentation title: Local/Cervical Block Anesthesia Versus General Anesthesia for Minimally Invasive Parathyroidectomy: What are the Advantages? Poster 14.]