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Successful awake total thyroidectomy using a bilateral intermediate cervical plexus block technique in a high-risk
Amal A Abu Jheasha1,2, Mohammad Alballasi3, Tasneem Alsharif3
1Alia governmental Hospital, Hebron, State of Palestine.
Introduction:
Ankylosing spondylitis (AS), a chronic inflammatory arthritis, affects the spine and sacroiliac joints. Awake thyroidectomy is a safe operation for high-risk patients, with local anesthesia often needed.
Importance:
The choice between general and loco-regional anesthetic techniques is challenging due to technical difficulties in high-risk patients.
Case Presentation:
A 52-year-old male patient with neck pain and anterior neck swelling was diagnosed with thyroid cancer. Ultrasound scans revealed bilateral thyroid nodules, and a total thyroidectomy was performed under regional anesthesia. A patient with severe ankylosing spondylitis (AS), lung fibrosis, and Grade 3 Mallampati score underwent total thyroidectomy under local anesthesia using the bilateral intermediate cervical plexus block technique (BICPB).
Clinical Discussion:
The patient's condition, including AS and other comorbidities, made intubation difficult due to vertebral bone fusion, back and neck flexibility loss, and possible temporomandibular joint disease. The patient's high American Society of Anesthesiologists (ASA) Classification System led to the use of local anesthesia with BICPB, avoiding general anesthesia with placed endotracheal tube (ET tube). The intermediate cervical plexus block (ICPB) technique is a non-invasive procedure that reduces postoperative respiratory events and improves outcomes. It is particularly effective in patients with lung fibrosis. However, concerns about potential complications, such as bilateral phrenic nerve palsy, respiratory failure, and infections, persist.
Conclusion:
This case report highlights the use of bilateral cervical plexus block (BICPB) in patients with ankylosing spondylitis and other comorbidities after a total thyroidectomy. This method is safer and more effective than general anesthesia, providing pain-free periods and reducing the need for analgesics and opioids. However, anesthesiologists must consider the disease extension, upper airway involvement, positioning difficulties, and technical difficulties when planning anesthesia management.
