Randomized clinical trial comparing regional and general anaesthesia in minimally invasive video-assisted parathyroidectomy

Background: This randomized clinical trial was performed in a single institution to compare the results of minimally invasive video-assisted parathyroidectomy (NIIVAP) conducted under regional anaesthesia (RA) or general anaesthesia (GA). Methods: Fifty-one patients undergoing MIVAP for primary hyperparathyroidism were assigned randomly to either RA (26 patients) or GA (25). RA involved a bilateral deep cervical block, and local infiltration of the incision site with a mixture of 0.25 per cent lignocaine and 0.15 per cent bupivacaine. GA was induced by intravenous administration of propofol, remifentanil and rocuronium bromide. Results: The two groups were matched for age, sex, adenoma size, and preoperative serum calcium and parathyroid hormone levels. The interval from skin incision to closure was similar in the two groups (27.6 and 25.8 min for RA and GA respectively), whereas the total operating time (from induction of anaesthesia to return to the ward) was significantly lower with RA (72.1 versus 90.2 min; P = 0.001). The postoperative requirement for pain medication, measured in terms of amount of ketorolac administered at the request of the patient, was significantly lower in the RA group (28.5 versus 80 mg/day; P < 0.001). Conclusion: MIVAP performed under RA was associated with a shorter overall operating time and a reduced need for postoperative pain relief.