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23-02-2006 | Thyroid | Article

Local anesthesia might enjoy revival for thyroidectomy

Abstract

Free abstract

Research reported in the Archives of Surgery indicates that contrary to common belief, local anesthetic techniques may be appropriate for patients undergoing thyroidectomy.

Early in the twentieth century, thyroid surgery was performed using local anesthetic techniques, but this approach was sidelined as general anesthetic techniques became safer, say lead author Samuel Snyder and colleagues, from the Scott & White Clinic and Foundation, in Temple, Texas, USA.

To assess if this preference was still valid, the team compared the two techniques in 58 patients who were randomly assigned to receive either local or general anesthesia during thyroidectomy.

The time spent in the operating room was on average, 150 and 163 minutes for patients in the local and general anesthesia groups, respectively, although this was not a significant difference.

Significantly, the use of the local anesthetic saved time because it "virtually eliminated" the need for patients to spend time in the post-anesthesia care unit, with patients in the local anesthetic group spending an average of four minutes in the unit, compared with 80 minutes for the general anesthetic group.

While nearly all the patients were discharged from hospital on the same day as they went in, individuals who received local anesthesia spent, on average, one hour less in the hospital than those who received general anesthesia, at 165 versus 229 minutes, respectively.

Of note, the cost savings to the hospital from using local anesthetic was estimated at $US 315 per patient, the investigators state.

Participants who underwent general anesthesia experienced more nausea and vomiting in the first 24 hours after surgery than those given local anesthetic, with rates at 55% versus 34%, respectively. Nevertheless, 30 days after surgery, the rates were equivalent between the groups.

"The positive experience from this prospective randomized study indicated that either local anesthesia with monitored anesthesia care or general anesthesia could be offered to acceptable thyroidectomy candidates, such as those treated in this study, with the expectation of equal clinical outcomes and patient satisfaction," Snyder et al conclude.