NESS - 2010 Annual Meeting Abstracts: Regional Anesthesia for Thyroid and Parathyroid Surgery: Development of a Gold Standard Technique

2010 Annual Meeting Abstracts

Regional Anesthesia for Thyroid and Parathyroid Surgery: Development of a Gold Standard Technique
*Jason D Prescott, Robert Udelsman
Yale University School of Medicine, New Haven, CT

Objective: To develop an anatomically-based standard protocol for superficial cervical nerve plexus regional anesthesia during parathyroid and thyroid surgery.
Design: Cadaveric case series
Setting: Tertiary referral center
Patients: Unembalmed human cadavers
Interventions: Ten unilateral neck microdissections were performed following cervical methylene blue dye injection in randomly selected, unembalmed human cadavers. Initial dissections were performed after simulation of a typical cervical nerve block technique using methylene blue dye in place of local anesthetic. Regional anesthetic technique for superficial cervical nerve block was then progressively refined during each subsequent dissection.
Main Outcome Measures: 1. Precise anatomic characterization of the superficial cervical nerve plexus.
2. Characterization of the anatomic distribution of simulated local anesthetic injectate, relative to the superficial cervical nerve plexus and surrounding structures, with correlation to injection technique
Results: Progressive refinement of simulated superficial cervical plexus regional anesthesia technique demonstrated that a single, precisely targeted low volume injection of methylene blue dye is adequate to stain (anesthetize) the superficial cervical nerve plexus at its origin along posterior border of the sternocleidomastoid muscle.
Conclusions: This is the first study to clearly characterize the anatomy of the superficial cervical nerve plexus and to use this anatomy for refinement of surgical technique. The data show that: 1. Regional anesthesia for thyroid and parathyroid surgery may be accomplished using a single low volume injection of local anesthetic and 2. Current techniques for superficial cervical nerve plexus block are based on imprecise anatomic information and involve unnecessary injections of excessive local anesthetic.

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