Površinski in kombinirani blok vratnega pleteža za minimalno invazivno paratirodektomijo Superficial and combined cervical plexus block for minimally invasive parathyroidectomy

comparison of their efficiency and safety

Abstract

Uvajanje minimalno invazivnih kirurških tehnik je vzpodbudilo tudi uvajanje manj invazivnih anestezioloških tehnik. S študijo, ki smo jo med letoma 2004 in 2006 izvedli na Onkološkem inštitutu v Ljubljani na bolnikih, operiranih zaradi primarnega hiperparatiroidizma, smo dokazali, da lahko minimalno invazivno paratiroidektomijo enako uspešno opravimo v preprostejšem in manj nevarnem, torej manj invazivnem površinskem bloku vratnega pleteža. Površinski in kombinirani blok vratnega pleteža se namreč nista razlikovala v času do začetka delovanja, učinkovitosti, stopnji zadovoljstva bolnikov, v času do prve prošnje za analgetik po operaciji ter v številu zapletov in sopojavov. Prav tako ni bilo razlik v plazemskih nivojih 0,5-odstotnega levobupivakaina, ki so bili v odmerku 0,35 mL/kg daleč pod toksičnimi nivoji.

Abstract (Eng)

The use of minimally invasive surgical techniques has, in turn, enhanced the application of minimally invasive anesthetic techniques. Our prospective, randomized and observer-blinded study, conducted at the Institute of Oncology Ljubljana in the years from 2004 to 2006, was performed on 42 patients randomized to receive either a superficial or a combined deep and superficial cervical plexus block (with 0.35 mL/ kg of 0.5% levobupivacaine for minimally invasive parathyroidectomy (MIP) to compare anesthetic efficacy, need for intraoperative analgesic supplementation, time to first postoperative analgesic request, patient satisfaction, complications and side effects. The results of the present investigation confirmed that the superficial CPB provides sufficient anesthesia for minimally invasive parathyroidectomy with less potential complications and side-effects in comparison with the combined CPB, thus additionally reducing the duration of treatment, hospitalization and treatment expenses.