Ann Surg Treat Res.  2015 Apr;88(4):193-199. 10.4174/astr.2015.88.4.193.

The benefits of preincision ropivacaine infiltration for reducing postoperative pain after robotic bilateral axillo-breast approach thyroidectomy: a prospective, randomized, double-blind, placebo-controlled study

• Kang KH
• Kim BS
• Kang H

• KMID: 2167014
• DOI: http://doi.org/10.4174/astr.2015.88.4.193

Abstract

PURPOSE
The aim of this study was to evaluate the effects of preoperative ropivacaine infiltration in patients undergoing robotic thyroidectomy using the bilateral axillary breast approach method.
METHODS
Using a randomized, double-blind study design, 34 consecutive female patients who underwent robotic thyroidectomy were randomly assigned to receive local infiltration to the skin flap site using either only 0.9% saline solution, 3 mL/kg (group C, n = 17) or 0.1% ropivacaine with saline, 3 mg/kg (group L, n = 17). Local anesthetic was administered prior to skin incision after the induction of general anesthesia. Postoperative pain was rated at 2, 6, 18, 30, 42, and 66 hours postoperatively by visual analogue scale (VAS) score. The bottom hit counts (BHC) from patient controlled analgesia and fentanyl consumption were evaluated. CRP levels, mean blood pressure (BP), and heart rate (HR) were also evaluated.
RESULTS
VAS pain scores were significantly lower in group L than in group C from 2 to 42 hours (P < 0.05). Fentanyl use for analgesia and BHC were also significantly lower in group L compared with group C during the first postoperative 6 and 2 hours, respectively (P < 0.05). The total consumption of fentanyl was significantly lower in group L than in group C (P = 0.009). No significant differences were noted for baseline, postoperative mean BP, or HR.
CONCLUSION
Preoperative infiltration using ropivacaine with saline to all flap sites is a safe and effective method for reducing postoperative pain and postoperative fentanyl consumption in patients with robotic thyroidectomy.

Keyword

Robotics; Thyroidectomy; Pain

MeSH Terms

Analgesia
Analgesia, Patient-Controlled
Anesthesia, General
Blood Pressure
Breast
Double-Blind Method
Female
Fentanyl
Heart Rate
Humans
Pain, Postoperative*
Prospective Studies*
Robotics
Skin
Sodium Chloride
Thyroidectomy*
Fentanyl
Sodium Chloride

Figure

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  Fig. 1 The wide robot flap dissection area. The infiltrated area before incision.

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  Fig. 2 Postoperative pain scores were lower in the ropivacaine group than in the control group after robotic thyroidectomy using bilateral axillo-breast approach. Values are expressed as mean ± standard error. Group C, saline infiltration group; group L, 0.1% ropivacaine infiltration group; VAS, visual analogue scale. *P < 0.05 compared with group C.

• 

  Fig. 3 Additional fentanyl use was lower in the ropivacaine group than in the control group at postoperative 2 and 6 hours. Values are expressed as mean ± standard error. Group C, saline infiltration group; group L, 0.1% ropivacaine infiltration group. *P < 0.05 compared with group C.

• 

  Fig. 4 The frequency bottom hit counts (BHC) were lower in the ropivacaine group than in the control group at postoperative 2 hours. Values are expressed as mean ± standard error. Group C, saline infiltration group; group L, 0.1% ropivacaine infiltration group. *P < 0.05 compared with group C.

• 

  Fig. 5 The postoperative CRP levels were not significantly different between the two groups. group C, saline infiltration group; group L, 0.1% ropivacaine infiltration group. Values are expressed as mean ± standard error.

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