Ketamine Versus Dexmedetomidine as Adjuvants to Bupivacaine in Ultrasound Guided Bilateral Superficial Cervical Plexus Block in Thyroidectomy

Tanta University60 enrolled

Overview

The aim of this study is to compare the analgesic efficacy of Dexmedetomidine and Ketamine as adjuvants to Bupivacaine in ultrasound-guided Bilateral SCPB in patients undergoing thyroidectomy

Thyroid gland disorders are relatively widespread. These conditions encompass a range of issues, including hypothyroidism, hyperthyroidism, goiter, thyroid nodules, thyroiditis, and various forms of thyroid cancer. While some thyroid conditions can be effectively managed through medical treatment alone, surgical intervention - particularly thyroidectomy - continues to play a central role in addressing both benign and malignant thyroid diseases. Despite being a relatively safe operation, various complications can occur including postoperative pain, which remains a significant concern affecting patient comfort, recovery, and overall satisfaction. Poorly controlled postoperative pain may result in adverse events that may prolong the patient's hospital stay, delay patient recovery, and affect the patient's experience with the health care system. The aim of this study is to compare the analgesic efficacy of Dexmedetomidine and Ketamine as adjuvants to Bupivacaine in ultrasound-guided Bilateral SCPB in patients undergoing thyroidectomy Adequate postoperative pain management is essential for enhancing functional recovery, promoting early mobilization, and facilitating timely discharge from the hospital. Post thyroidectomy pain may be treated with medical treatment like acetaminophen , non steroidal anti inflammatory drugs or opioids. However, many surgeons are reluctant to use NSAIDs so soon after the procedure because of gastric upset and bleeding disorders , also can be treated by local infiltration or regional block. Opioids are commonly administered to relieve postoperative pain; however, their use is often associated with undesirable side effects such as nausea, vomiting, and respiratory depression. Effective management of postoperative pain is a crucial factor in ensuring a high quality of recovery following surgery. Ultrasound -guided superficial cervical plexus block offers several key advantages. These include real-time visualization of anatomical structures, the use of reduced volumes of local anesthetics, and a lower risk of inadvertent vascular injury or accidental puncture. Due to its practicality and effectiveness, ultrasound-guided bilateral superficial cervical plexus block has become a valuable technique for providing effective regional analgesia during thyroidectomy, contributing to improved patient recovery. Ketamine and dexmedetomidine are two promising adjuvants that have been studied extensively in regional anesthesia due to their distinct yet complementary mechanisms of action. ketamine, a non-competitive N-methyl-D-aspartate receptor antagonist, attenuates central sensitization and hyperalgesia, thereby extending the duration of peripheral nerve blocks. Its role in reducing opioid consumption and preventing chronic post-surgical pain has been well-documented. Dexmedetomidine, a highly selective α-2 adrenergic agonist, exerts its analgesic effects through both peripheral and central mechanisms, including inhibition of nociceptive neurotransmission and sympathetic outflow. There is no study uptill now comparing the analgesic effect of dexmedetomidine and ketamine as an adjuvants in ultrasound guided bilateral superficial cervical plexus block for more hemodynamics satability.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

DOUBLE

Enrollment

Conditions

Thyroidectomy Bupivacaine Dexmedetomidine

Interventions

Group C (Control group)DRUG

Patients will only receive bilateral SCPB with 45mg bupivacaine diluted with normal saline (18 mL; 9 mL on each side) after intubation and before surgical incision.

Group D (Dexmedetomidine group)DRUG

Patients will receive general anesthesia plus US guided Bilateral SCPB with 45mg bupivacaine diluted with normal saline to 16mL and 1 μg/kg dexmedetomidine diluted with normal saline to 2mL (total volume, 18 mL; 9 mL on each side) after intubation and before surgical incision.

Group K (Ketamine group)DRUG

Patients will receive general anesthesia plus US guided Bilateral SCPB with 45mg bupivacaine diluted with normal saline to 16 mL and 1 mg/kg ketamine diluted with normal saline to 2 mL (total volume, 18 mL; 9 mL on each side) after intubation and before surgical incision.

Eligibility

Sex: ALLMin age: 19 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients aged more than 18 years * American Society of Anesthesiologists physical status I or II * scheduled for elective thyroid surgery will be included in the study. Exclusion Criteria: 1. Patients who refuse to participate in the study. 2. Patients presented with mental and memory dysfunction. 3. Patients with history of allergy to local anesthetics. 4. Patients with history of chronic use of pain killers )most days for more than 3 months). 5. Patients presented with skin or soft tissue infection at the proposed site of needle. 6. Pre-existing major organ dysfunction such as hepatic or renal impairment.

Locations (1)

Tanta University

Tanta, Egypt

Outcomes

Primary Outcomes

Morphine consumption

total 24 hours Morphine consumption(mg)

Time frame: 24 hours

Secondary Outcomes

Assessment of post operative pain

Assessment of post operative pain using the Visual Analogue Scale

Time frame: immediately (T0),15 mins(T1),30 mins(T2),1 hour(T3),2 hours(T4),4 hours(T5)8 hours(T6),12 hours(T7),18 hours(T8),24 hours(T9) after arrival to recovery room

Data from ClinicalTrials.gov

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