Local anaesthesia feasible for thyroidectomy

A recent report described 1,025 consecutive patients treated by a single surgeon during 16 years. Surgery was conducted under monitored intravenous propofol sedation with an anaesthetist present, and local anaesthesia provided a superficial cervical block.About half the patients had total thyroidectomy, the remainder having lobectomy or partial resections. Cancer was the most common indication (45%), followed by a benign thyroid condition (39%) and thyroid adenoma (15%). Most patients (90%) were classified as at low to intermediate risk for general anaesthesia, but the proportion of high-risk, older and obese patients expanded with the accumulation of more experience. More extensive resections and bilateral procedures also became more common with experience. Only 34 patients (3.3%) required conversion to general anaesthesia, for reasons including inadequate local anaesthesia for resection of large and complicated goitres, and the need for lymphadenectomy on discovering an unexpected cancer.The vast majority of patients were discharged on the day of surgery. Complications were rare, and not related to the choice of anaesthetic technique. One advantage of local anaesthesia was the ability to lighten sedation and ask the patient to speak, checking for injury to the recurrent laryngeal nerve.Patients reported having a favourable experience, especially those with particular fears about a general anaesthetic. More than half said it had been less painful or frightening than having a dental cavity filled.The report said local anaesthesia for thyroidectomy had come full circle. Fifty years ago it was the method of choice for safely managing patients with complicating thyrotoxicosis, large goitres and high anaesthetic risk. Advances in anaesthesia had removed most of those concerns, but a new set of advantages had emerged for local techniques.Reference...