Multimodal Analgesia with Local Wound Infiltration and Intravenous Parecoxib for Thyroidectomy

Area of Science:

• Anesthesiology
• Surgical Pain Management

Background:

• Effective postoperative pain control is crucial for patient recovery after thyroidectomy.
• Multimodal analgesia strategies are commonly employed to manage surgical pain.
• Lidocaine wound infiltration and superficial cervical plexus blocks are recognized pain management techniques for thyroid surgery.

Purpose of the Study:

• To evaluate the efficacy of multimodal analgesia using lidocaine wound infiltration combined with intravenous parecoxib in patients undergoing thyroidectomy.
• To compare the pain intensity and adverse events between different dosages of lidocaine infiltration.

Main Methods:

• A retrospective analysis of 101 patients undergoing thyroidectomy with a multimodal analgesia protocol.
• Patients received either 5 mL (Group I, control) or 10 mL (Group II, study) of 1% lidocaine with epinephrine infiltration, alongside 40 mg intravenous parecoxib.
• Pain intensity was assessed using the Numerical Rating Scale (NRS) at the postoperative anesthetic care unit and on postoperative day 1.
• Secondary outcomes included anesthetic-related side effects and pulmonary complications.

Main Results:

• Patients in Group II (10 mL lidocaine) reported significantly lower pain intensity during motion (NRS 1.47 ± 0.89 vs. 1.85 ± 0.96, p=0.043) and coughing (NRS 1.61 ± 0.95 vs. 1.96 ± 0.79, p=0.049) in the postoperative anesthetic care unit compared to Group I (5 mL lidocaine).
• The majority of patients experienced no or mild postoperative pain.
• No severe adverse events were reported; one patient in Group I experienced temporary vocal palsy.

Conclusions:

• Multimodal analgesia with lidocaine wound infiltration and intravenous parecoxib provides effective pain relief after thyroidectomy.
• A higher volume of lidocaine infiltration (10 mL) may offer superior pain control during motion and coughing compared to a lower volume (5 mL).
• This analgesic approach is associated with minimal adverse events, including temporary vocal palsy.