Regional Anesthesia in Thyroid Surgery for a Giant Intrathoracic Goiter With Tracheal Compression

Cervical plexus block (CPB), like other types of regional anesthesia, represents an alternative anesthetic technique in those cases where the performance of general anesthesia (GA) carries an increased risk both for the patient and the outcome of the operative treatment. It has traditionally been used for years in carotid surgery as an alternative to GA, especially due to the possibility of superior monitoring - the awake patient. However, its effectiveness has been proven in other types of neck surgery, primarily in thyroid surgery, neck dissections, tracheostomy, central venous catheter insertion, clavicle surgery, etc. In most cases, it provides adequate and satisfactory analgesia of the anterolateral side of the neck (C1-C4 roots), at the same time avoiding all the negative effects on the patient that GA entails. Superficial block of the cervical plexus (SBCP) is a variant known for its simplicity and low number of complications. It can be performed traditionally with the help of external landmarks or with ultrasound-guided orientation.  The case report describes the anesthesiology challenges of maintaining the airway caused by a high degree of compression by the retrosternal goiter and the possibility of performing such an operation under regional anesthesia. In this case, a male patient in his seventies presented with a giant retrosternal goiter and symptoms associated with tracheal compression. Due to significant tracheal narrowing, induction of general endotracheal anesthesia was not possible. The surgical treatment was performed through a low-collar incision with neck extension under bilateral superficial cervical plexus (BSCPB) block anesthesia. The study concludes that BSCPB can provide a satisfactory degree of analgesia for operative procedures like this, where GA poses a high risk.