Ultrasound-guided bilateral superficial cervical block and preemptive single-dose oral tizanidine for post-thyroidectomy pain: a randomized-controlled double-blind study.

PURPOSES: The postoperative analgesic effect of tizanidine has not yet been evaluated sufficiently. The role of bilateral superficial cervical plexus block (BSCPB) for postoperative analgesia after thyroidectomy remains questionable. We aimed to evaluate the analgesic effect of combined use of BSCPB and a single-dose oral tizanidine in patients undergoing elective thyroid surgery. METHODS: Sixty patients undergoing thyroidectomy were randomized into 3 groups. The control group (Group C, n = 20) received BSCPB with 0.9% saline plus oral placebo. The superficial cervical group (Group SC, n = 20) received BSCPB with 0.25% bupivacaine plus oral placebo. The superficial cervical and tizanidine group (Group SC + T, n = 20) received BSCPB with 0.25% bupivacaine plus tizanidine 6 mg capsule. Surgical site pain scores, opioid consumption, rescue analgesia, posterior neck pain, headache, and opioid-related side effects were assessed for the first 24 h. RESULTS: Compared with Group C, rest and swallowing pain scores in Group SC and Group SC + T were statistically lower at all postoperative time points (p < 0.05). Fentanyl consumption was lower in Group SC and Group SC + T than in Group C at time periods 0-4 and 4-8 h (p < 0.05). Fentanyl consumption was lower in Group SC + T than in Group SC at 0-4 h (p = 0.006). Total fentanyl consumption was higher in Group C than in the other groups (p < 0.001). Postoperative cervical pain and occipital headache were significantly lower in Group SC + T than in the other groups (p < 0.05). CONCLUSIONS: Ultrasound-guided BSCPB with or without preemptive oral tizanidine was effective at reducing postoperative pain and opioid consumption in patients undergoing total thyroidectomy. Addition of preemptive oral tizanidine to BSCPB reduced the early postoperative opioid consumption, posterior neck pain, and occipital headache. CLINICAL TRIALS REGISTRY: The study was registered with a clinical trials registry (ClinicalTrials.gov. identifier NCT02725359).

Brachiocephalic artery anomaly at the neck: importance during minimally invasive video-assisted parathyroidectomy.

A 76-year-old woman was referred to our hospital for evaluation of a parathyroid adenoma, detected on sonography. It had been located posteroinferiorly to the right thyroid lobe. Parathyroid scintigraphy confirmed the right inferior parathyroid adenoma. During physical examination of the neck, a pulsatile mass in the anterior inferior right was determined, and because of suspicion for a vascular anomaly, a computed tomography angiography was performed. The computed tomography showed that the right brachiocephalic artery ascended vertically to the level of the inferior border of right thyroid lobe and dividing into the right common carotid artery and subclavian artery at this level. Right subclavian artery after its origin brought about a curve by means of turning first posteromedially and then anterolaterally. Parathyroid adenoma remained between the right thyroid lobe, right common carotid artery, and right brachiocephalic artery. Minimally invasive video-assisted parathyroidectomy was performed and no complication appeared.

Auditory Function of Patients with Obstructive Sleep Apnea Syndrome: A Study.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) is a respiratory syndrome that manifests during sleep. For the auditory system to be able to function normally, the inner ear and cochlear nerve require healthy oxygen support. The purpose of this study was to assess the hearing function of patients with OSAS and to reveal the relationship between polysomnographic parameters and hearing test results. MATERIALS AND METHODS: The study was performed with 35 patients diagnosed with moderate or severe OSAS using polysomnography and a control group consisting of 30 individuals. The snoring, tiredness, observed apnea, blood pressure, body mass index, age, neck circumference and gender (STOP-Bang) questionnaire was used to establish the control group. Detailed otoscopic examinations were administered to all subjects by the same otolaryngologist, followed by a tympanogram, pure-tone audiometry (PTA) and transient evoked otoacoustic emissions (TEOAE) tests. RESULTS: We determined mild sensorineural hearing loss in patients with OSAS. When the different frequencies were evaluated separately, hearing threshold values in the patients with OSAS were significantly higher compared to the control group at 500, 1000, 2000, 4000, and 8000 Hz in both ears. TEOAE test reproducibility values in both ears were significantly lower in the study group compared to the control group. CONCLUSION: The hearing system is affected to varying degrees in patients with OSAS. If hearing loss is detected in patients presenting at otolaryngology clinics due to snoring, then assessing these subjects in terms of risk of OSAS is important to reduce mortality and morbidity that may develop at later stages in association with OSAS.