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Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 8/2015

01.08.2015 | Reports of Original Investigations

Effect of superficial cervical plexus block on postoperative quality of recovery after anterior cervical discectomy and fusion: a randomized controlled trial

verfasst von: Ramamani Mariappan, MD, Jigesh Mehta, MD, Eric Massicotte, MD, Mahesh Nagappa, MD, Pirjo Manninen, MD, Lashmi Venkatraghavan, MD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 8/2015

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Abstract

Purpose

Spine surgeries are increasingly being performed as a day or short-stay surgery programs. Peripheral nerve block provide site-specific pain relief with few side effects, thereby reducing surgical stress and enhancing quality of recovery. The aim of our study was to determine the effect of a superficial cervical plexus block (SCPB) on postoperative quality of recovery and analgesia in patients undergoing elective anterior cervical discectomy and fusion (ACDF).

Methods

After Research Ethics Board approval, we enrolled adults (> 18 yr) scheduled for elective single- or two-level ACDF in this randomized double-blind clinical trial. Participants were randomized to receive either a SCPB (0.25% bupivacaine, 10 mL) or No Block. The primary outcome measure was the quality of recovery at 24 hr, measured using the 40-item quality of recovery questionnaire (QoR-40). In addition, comparisons between groups were also made for postoperative opioid consumption and discharge times.

Results

Forty-six patients were randomized to receive either a SCPB block (n = 23) or No Block (n = 23). Median [interquartile range] aggregated global QoR-40 scores at 24 hr were significantly greater in the SCPB group, indicating good quality of recovery compared with the No Block group (179 [116-195] vs 157 [97-196], respectively; median difference, 22; 95% confidence interval [CI], 7 to 34; P = 0.002]. There were no differences between the SCPB and the No Block group with regard to mean (standard deviation) postoperative opioid consumption at 24 hr [22.9 (13.6) mg vs 24.6 (9.5) mg, respectively; mean difference 1.7; 95% CI, −5.2 to 8.7; P = 0.620] and the number of patients discharged within 24 hr (15 vs 12, respectively; P = 0.550).

Conclusion

We showed that preoperative SCPB is an effective strategy for improving the early quality of recovery in patients undergoing single- or two-level ACDF. Nevertheless, there was no impact on opioid consumption or discharge times. This trial was registered at www.​clinicaltrials.​gov (NCT01662219).
Literatur
1.
Zurück zum Zitat Tomaras CR, Blacklock JB, Parker WD, Harper RL. Outpatient surgical treatment of cervical radiculopathy. J Neurosurg 1997; 87: 41-3.PubMedCrossRef Tomaras CR, Blacklock JB, Parker WD, Harper RL. Outpatient surgical treatment of cervical radiculopathy. J Neurosurg 1997; 87: 41-3.PubMedCrossRef
2.
Zurück zum Zitat Garringer SM, Sasso RC. Safety of anterior cervical discectomy and fusion performed as outpatient surgery. J Spinal Discord Tech 2010; 23: 439-43.CrossRef Garringer SM, Sasso RC. Safety of anterior cervical discectomy and fusion performed as outpatient surgery. J Spinal Discord Tech 2010; 23: 439-43.CrossRef
3.
Zurück zum Zitat McGrath B, Elgendy H, Chung F, Kamming D, Curti B, King S. Thirty percent of patients have moderate to severe pain 24 hr after ambulatory surgery: a survey of 5,703 patients. Can J Anesth 2004; 51: 886-91.PubMedCrossRef McGrath B, Elgendy H, Chung F, Kamming D, Curti B, King S. Thirty percent of patients have moderate to severe pain 24 hr after ambulatory surgery: a survey of 5,703 patients. Can J Anesth 2004; 51: 886-91.PubMedCrossRef
4.
Zurück zum Zitat Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976) 2002; 27: 2453-8. Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976) 2002; 27: 2453-8.
5.
Zurück zum Zitat Frempong-Boadu A, Houten JK, Osborn B, et al. Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment. J Spinal Disord Tech 2002; 15: 362-8.PubMedCrossRef Frempong-Boadu A, Houten JK, Osborn B, et al. Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment. J Spinal Disord Tech 2002; 15: 362-8.PubMedCrossRef
6.
Zurück zum Zitat Niijima K, Malis L. Preventive superficial cervical plexus block for postoperative cervicocephalic pain in neurosurgery. Neurol Med Chir (Tokyo) 1993; 33: 365-7.CrossRef Niijima K, Malis L. Preventive superficial cervical plexus block for postoperative cervicocephalic pain in neurosurgery. Neurol Med Chir (Tokyo) 1993; 33: 365-7.CrossRef
7.
Zurück zum Zitat Sagi HC, Beutler W, Carroll E, Connolly PJ. Airway complications associated with surgery on the anterior cervical spine. Spine (Phila Pa 1976) 2002; 27: 949-53. Sagi HC, Beutler W, Carroll E, Connolly PJ. Airway complications associated with surgery on the anterior cervical spine. Spine (Phila Pa 1976) 2002; 27: 949-53.
8.
Zurück zum Zitat Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications. Spine 2007; 32: 2310-7.PubMedCrossRef Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications. Spine 2007; 32: 2310-7.PubMedCrossRef
9.
Zurück zum Zitat Suk KS, Kim KT, Lee SH, Park SW. Prevertebral soft tissue swelling after anterior cervical discectomy and fusion with plate fixation. Int Orthop 2006; 30: 290-4.PubMedCentralPubMedCrossRef Suk KS, Kim KT, Lee SH, Park SW. Prevertebral soft tissue swelling after anterior cervical discectomy and fusion with plate fixation. Int Orthop 2006; 30: 290-4.PubMedCentralPubMedCrossRef
10.
Zurück zum Zitat Elvir-Lazo OL, White PF. The role of multimodal analgesia in pain management after ambulatory surgery. Curr Opin Anaesthesiol 2010; 23: 697-703.PubMedCrossRef Elvir-Lazo OL, White PF. The role of multimodal analgesia in pain management after ambulatory surgery. Curr Opin Anaesthesiol 2010; 23: 697-703.PubMedCrossRef
11.
Zurück zum Zitat De Oliveira GS, Jr Fitzgerald PC, Marcus RJ, Ahmad S, McCarthy RJ. A dose-ranging study of the effect of transversus abdominis block on postoperative quality of recovery and analgesia after outpatient laparoscopy. Anesth Analg 2011; 113: 1218-25.PubMedCrossRef De Oliveira GS, Jr Fitzgerald PC, Marcus RJ, Ahmad S, McCarthy RJ. A dose-ranging study of the effect of transversus abdominis block on postoperative quality of recovery and analgesia after outpatient laparoscopy. Anesth Analg 2011; 113: 1218-25.PubMedCrossRef
12.
Zurück zum Zitat Gornall BF, Myles PS, Smith CL, et al. Measurement of quality of recovery using the QoR-40: a quantitative systematic review. Br J Anaesth 2013; 111: 161-9.PubMedCrossRef Gornall BF, Myles PS, Smith CL, et al. Measurement of quality of recovery using the QoR-40: a quantitative systematic review. Br J Anaesth 2013; 111: 161-9.PubMedCrossRef
13.
Zurück zum Zitat Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 1991; 7: 409-15. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 1991; 7: 409-15.
14.
Zurück zum Zitat Leslie K, Troedel S, Irwin K, et al. Quality of recovery from anesthesia in neurosurgical patients. Anesthesiology 2003; 99: 1158-65.PubMedCrossRef Leslie K, Troedel S, Irwin K, et al. Quality of recovery from anesthesia in neurosurgical patients. Anesthesiology 2003; 99: 1158-65.PubMedCrossRef
15.
Zurück zum Zitat De Oliveira GS, Jr Fitzgerald P, Streicher LF, Marcus RJ, McCarthy RJ. Systemic lidocaine to improve postoperative quality of recovery after ambulatory laparoscopic surgery. Anesth Analg 2012; 115: 262-7.PubMedCrossRef De Oliveira GS, Jr Fitzgerald P, Streicher LF, Marcus RJ, McCarthy RJ. Systemic lidocaine to improve postoperative quality of recovery after ambulatory laparoscopic surgery. Anesth Analg 2012; 115: 262-7.PubMedCrossRef
16.
Zurück zum Zitat De Oliveira GS, Jr Milad MP, Fitzgerald P, Rahmani R, McCarthy RJ. Transversus abdominis plane infiltration and quality of recovery after laparoscopic hysterectomy: a randomized controlled trial. Obstet Gynecol 2011; 118: 1230-7.PubMedCrossRef De Oliveira GS, Jr Milad MP, Fitzgerald P, Rahmani R, McCarthy RJ. Transversus abdominis plane infiltration and quality of recovery after laparoscopic hysterectomy: a randomized controlled trial. Obstet Gynecol 2011; 118: 1230-7.PubMedCrossRef
17.
Zurück zum Zitat Myles PS, Hunt JO, Nightingale CE, et al. Development and psychometric testing of a quality of recovery score after general anesthesia and surgery in adults. Anesth Analg 1999; 88: 83-90.PubMed Myles PS, Hunt JO, Nightingale CE, et al. Development and psychometric testing of a quality of recovery score after general anesthesia and surgery in adults. Anesth Analg 1999; 88: 83-90.PubMed
18.
Zurück zum Zitat Cai HD, Lin CZ, Yu CX, Lin XZ. Bilateral superficial cervical plexus block reduces postoperative nausea and vomiting and early postoperative pain after thyroidectomy. J Int Med Res 2012; 40: 1390-8.PubMedCrossRef Cai HD, Lin CZ, Yu CX, Lin XZ. Bilateral superficial cervical plexus block reduces postoperative nausea and vomiting and early postoperative pain after thyroidectomy. J Int Med Res 2012; 40: 1390-8.PubMedCrossRef
19.
Zurück zum Zitat Aunac S, Carlier M, Singelyn F, De Kock M. The analgesic efficacy of bilateral combined superficial and deep cervical plexus block administered before thyroid surgery under general anesthesia. Anesth Analg 2002; 95: 746-50.PubMed Aunac S, Carlier M, Singelyn F, De Kock M. The analgesic efficacy of bilateral combined superficial and deep cervical plexus block administered before thyroid surgery under general anesthesia. Anesth Analg 2002; 95: 746-50.PubMed
20.
Zurück zum Zitat Dieudonne N, Gomola A, Bonnichon P, Ozier YM. Prevention of postoperative pain after thyroid surgery: a double-blind randomized study of bilateral superficial cervical plexus blocks. Anesth Analg 2001; 92: 1538-42.PubMedCrossRef Dieudonne N, Gomola A, Bonnichon P, Ozier YM. Prevention of postoperative pain after thyroid surgery: a double-blind randomized study of bilateral superficial cervical plexus blocks. Anesth Analg 2001; 92: 1538-42.PubMedCrossRef
21.
Zurück zum Zitat Pandit JJ, Bree S, Dillon P, Elcock D, McLaren ID, Crider B. A comparison of superficial versus combined (superficial and deep) cervical plexus block for carotid endarterectomy: a prospective, randomized study. Anesth Analg 2000; 91: 781-6.PubMedCrossRef Pandit JJ, Bree S, Dillon P, Elcock D, McLaren ID, Crider B. A comparison of superficial versus combined (superficial and deep) cervical plexus block for carotid endarterectomy: a prospective, randomized study. Anesth Analg 2000; 91: 781-6.PubMedCrossRef
22.
Zurück zum Zitat Stoneham MD, Doyle AR, Knighton JD, Dorje P, Stanley JC. Prospective, randomized comparison of deep or superficial cervical plexus block for carotid endarterectomy surgery. Anesthesiology 1998; 89: 907-12.PubMedCrossRef Stoneham MD, Doyle AR, Knighton JD, Dorje P, Stanley JC. Prospective, randomized comparison of deep or superficial cervical plexus block for carotid endarterectomy surgery. Anesthesiology 1998; 89: 907-12.PubMedCrossRef
23.
Zurück zum Zitat Pinto Neto W, IssyAM, Sakata RK. A comparative study between bupivacaine and clonidine associated with bupivacaine in cervical plexus block for carotid endarterectomy (Portuguese). Rev Bras Anestesiol 2009; 59: 387-95. Pinto Neto W, IssyAM, Sakata RK. A comparative study between bupivacaine and clonidine associated with bupivacaine in cervical plexus block for carotid endarterectomy (Portuguese). Rev Bras Anestesiol 2009; 59: 387-95.
24.
Zurück zum Zitat Pandit JJ, Satya-Krishna R, Gration P. Superficial or deep cervical plexus block for carotid endarterectomy: a systematic review of complications. Br J Anaesth 2007; 99: 159-69.PubMedCrossRef Pandit JJ, Satya-Krishna R, Gration P. Superficial or deep cervical plexus block for carotid endarterectomy: a systematic review of complications. Br J Anaesth 2007; 99: 159-69.PubMedCrossRef
Metadaten
Titel
Effect of superficial cervical plexus block on postoperative quality of recovery after anterior cervical discectomy and fusion: a randomized controlled trial
verfasst von
Ramamani Mariappan, MD
Jigesh Mehta, MD
Eric Massicotte, MD
Mahesh Nagappa, MD
Pirjo Manninen, MD
Lashmi Venkatraghavan, MD
Publikationsdatum
01.08.2015
Verlag
Springer US
Erschienen in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 8/2015
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-015-0382-3

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