Efficacy and Safety of Cervical Epidural Anesthesia for Thyroid Surgery

Background: Cervical epidural anesthesia (CEA) has been employed successfully for various types of surgical procedures involving upper limb surgery, thoracic wall surgery, carotid artery surgery, and neck dissections. Anesthesia for thyroidectomy in a patient with tracheal deviation due to the large size or altered functional status of the thyroid can be complicated. Endotracheal intubation is difficult in such cases and more prone to cardiac arrhythmia under the influence of inhalational anesthetics. Objectives: This prospective study was designed to assess the effectiveness and safety of CEA for thyroid surgery. Materials and Methods: Patients were divided on an alternate basis into two groups of 25 each. Group A to receive 10 ml of local anesthetic (1% lignocaine with adrenaline). Group B to receive conventional general anesthesia (GA) with endotracheal tube intubation. We compared their efficacy in terms of hemodynamic parameters, pulmonary parameters, blockade quality, and complications. Results: Of the total study: In Group A, 25 patients completed the study successfully. Sensory block attained the median dermatomal range of C-2-T-4/5. Hemodynamic parameters and respiratory parameters decreased, but none of the patients had any complications. In Group B, 25 patients received GA. Hemodynamic parameters and respiratory parameters in the beginning and end of the procedure were increased, attributed to intubation and extubation. Post-operative pain that required rescues analgesics. Conclusion: Cervical epidural route can be considered as a safe alternative to conventional GA for patients undergoing thyroid surgery where difficult intubation is anticipated and vulnerable to cardiovascular complications.