The analgesic effects of bilateral superficial cervical plexus block in thyroid surgery: A systematic review and meta-analysis

ABSTRACT

Background and Aims:

Thyroid surgery is moderately painful, and many techniques to reduce postoperative pain have been studied. Regional techniques are a part of multimodal analgesia employed for various surgical cases. Bilateral superficial cervical plexus block (BSCPB) is a commonly used regional anaesthesia technique for analgesia for thyroid surgery. A previous meta-analysis by this group had left questions about some facets of the technique, to which further trials have contributed.

Methods:

The systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) CRD42022315499. It is an update to a previously published paper in 2018. An updated systematic search, critical appraisal, and analysis of clinical trials were performed. Trials investigating preoperative or postoperative BSCPB compared to control in patients undergoing thyroid surgery were included in the search. The primary outcome was postoperative opioid consumption. The secondary outcomes were the duration of analgesia (time to request of analgesia), Visual Analogue Scale (VAS) pain scores at 0, 4, 12, and 24 h, postoperatively, rates of postoperative nausea and vomiting (PONV), postoperative rescue analgesic consumption, and intraoperative morphine use.

Results:

A total of 31 studies and 2,273 patients were included in this analysis. BSCPB significantly reduced post-thyroidectomy opioid consumption (P < 0.001). Additionally, the duration of analgesia was prolonged following BSCPB. VAS scores for 24 h (postoperatively), intraoperative morphine use, and rescue analgesia (postoperatively) remained significantly lower in patients who received BSCPB. There was also a statistically significant reduction in PONV (P = 0.02).

Conclusion:

BSCPB offers superior postoperative analgesia with a reduction in opioid use, reduction in PONV, and improvement in VAS scores.

INTRODUCTION

Thyroid surgery is associated with mild-to-moderate postoperative pain, felt most commonly at the incision site.[1] Use of simple non-opioid analgesics alone or in combination with intraoperative opioids does not diminish the need for opiates in the postoperative recovery area.[2] Multimodal analgesia, including regional techniques, has demonstrated a reduction in pain and the need for postoperative opioid administration during thyroid surgery.[3,4] The site of incision for thyroid surgery is amenable to regional anaesthetic techniques. Superficial cervical plexus block aims to anaesthetise the anterior neck’s sensory nerves and is easy to perform with a low risk of complications.[5]

A 2018 meta-analysis by the same authors demonstrated a reduction in the need for rescue analgesia when bilateral superficial cervical plexus block (BSCPB) was used in thyroid surgery.[6] However, several recent studies have investigated the effects of BSCPB on opioid consumption after said surgery. Our current meta-analysis analyses the updated evidence for BSCPB use in thyroid surgery.

METHODS

Our systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) CRD42022315499. The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards.[7]

Literature search

A systematic search was conducted using the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Google Scholar from January 2016 to January 2022. Studies published before January 2016 were available from the database of the previous meta-analysis. The keywords used in the search were “superficial cervical plexus block”, “thyroidectomy”, and “postoperative analgesia”. There were no language restrictions.

Eligibility criteria

All articles that investigated the analgesic effect of BSCPB by comparing it with a control group of no block or placebo block with saline in patients undergoing thyroidectomy were included in this review. Of the 17 included trials, 13 were randomised control trials (RCTs),[8–20] two were observational,[21,22] and two were cohort[23,24] studies. Non-RCT studies were included as they studied the defined outcomes and provided data for analysis. As Shrier et al.[25] outlined in their paper, including observational studies in a meta-analysis can improve the inferences made by RCTs alone and, therefore, should be considered advantageous. Including these trials and data in this analysis contrasts with the results of the previous meta-analysis that did not include non-RCTs.[6] Trials that compared BSCPB to other analgesic regimens or deep or intermediate cervical plexus blocks were excluded.

Selection process

Three authors (L.W., A.B., and R.M.) reviewed the retrieved abstracts from the literature search to exclude irrelevant studies. Data were then collected by L.W. and A.B. using a standardised collection form, which included the following: publication date, title, author, study group, type of the block performed, local anaesthetic used and its volume, the timing of block administration, intraoperative and postoperative analgesia, postoperative pain scores, time to first analgesic request, and incidence of postoperative nausea and vomiting (PONV).

Critical appraisal

A five-point Jadad score was applied to ensure consistency in the trial quality assessment. The Jadad score is an independently validated tool used to describe the quality of RCTs.[26] An initial score was assigned by L.W. and was confirmed in consultation with the co-authors. Risk of bias assessment was conducted using the Cochrane Risk of Bias tool, including selection bias (both the evaluation of random sequence generation and allocation concealment), performance bias (blinding of participants and personnel), detection bias (blinding of outcome assessment), attrition bias (incomplete outcome data), reporting bias (selective reporting), and other potential sources of bias.[27]

Study outcomes

The primary outcome of this meta-analysis was total morphine equivalent consumption during the first 24 h, postoperatively, with subgroup analysis of ultrasound (US)-guided or landmark technique BSCPB, three-point versus two-point versus one-point injection techniques, and saline placebo versus no block. Additionally, we considered US-guided BSCPB as a one-point technique and analysed outcomes as a one-point technique and US guidance.

Secondary outcomes were time to first analgesia in the postoperative period; pain scores as measured by the Visual Analogue Scale (VAS) at 0, 4, 12, and 24 h; the incidence of PONV; postoperative rescue analgesia; and intraoperative morphine use.

We considered that the VAS scores performed in the recovery room (RR) or post-anaesthesia care unit (PACU) was comparable to T0 (postoperative at 0 h) for analysis.[8] Additionally, pain scores at rest were used to analyse the VAS scores.[21]

BSCPB technique

Both landmark (LM) and US-guided techniques have been described in previous studies. The LM techniques included three-point injection, two-point injection, and one-point injection.

Trials using a three-point injection described an established technique: a local anaesthetic was injected subcutaneously along the posterior border of the sternocleidomastoid muscle in both the cranial and caudal directions from the midpoint, which aimed to block the transverse cervical, lesser occipital, greater auricular, and supraclavicular nerves. The two-point technique described by three studies demonstrated a heterogeneous technique: caudal and horizontal injection,[28] cranial and caudal injection,[29] and cranial and medial injection,[30] which spared the supraclavicular nerves. The one-point injection technique involved the injection of a local anaesthetic at the mid-point of the posterior edge of the sternocleidomastoid muscle.[13,23]

The US-guided techniques describe the same anatomical landmark of the midpoint of the posterior border of the sternocleidomastoid muscle for probe placement. The plexus is identified to guide local anaesthetic injection around the nerves.

Statistical analysis

All statistical analyses were executed using Review Manager (RevMan; Version 5.4.1 Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Dichotomous data were analysed using an odds ratio (OR) with a 95% confidence interval (95% CI); the results demonstrated statistical significance when the 95% CI did not include 1. The standardised mean difference (SMD) with a random-effects model was used to analyse continuous data. For all statistical tests, significance was set at P < 0.05, and heterogeneity was evaluated using the I² test.

In those studies where VAS scores were reported as median, we considered the mean equivalent to the median and estimated the standard deviation (SD) using the statistical formula range/4. When the interquartile range (IQR) was determined, SD was calculated using IQR/1.35. In studies where the standard error of the mean (SEM) was used, the calculation number (n) ^1/2 × SEM was used to estimate SD. For the primary outcome, calculations were performed to estimate the number needed to treat (NNT). To ensure consistency in analysing data regarding morphine consumption, a conversion of 1 μg fentanyl to 0.1 mg morphine equivalent and 1 μg sufentanil to 0.5 mg morphine equivalent was used.

Meta-regression and sensitivity analysis was performed following statistical analysis of the results to determine if heterogeneity was due to the year of publication, Jadad score, type or amount of local anaesthetic used, point of injection, US-guided or LM technique, and saline or no block. A cumulative analysis for the above moderators was also performed, including the “the one study removed” analysis.

Publication bias was evaluated using both Egger’s regression test and Begg and Mazumdar’s rank correlation tests, in addition to the “trim and fill effect”, to ascertain the number of missing studies. Precision modelling was also conducted on the above.

We performed a trial sequential analysis (TSA) using TSA Viewer (Version 0.9.5.10 Beta, Copenhagen Trial Unit, 2016, Copenhagen, Denmark). The Sidik–Jonkman random effects model was chosen to calculate the Z-statistic, as it is less likely to underestimate the heterogeneity between trials, equal to the meta-analysed intervention effect divided by its standard error. In the cumulative meta-analysis, adjusted significance testing has two purposes: one, to measure and account for the strength of the obtained evidence, and two, to control the risk of type 1 and type 2 statistical errors that occur when repeated significance testing is performed on accumulating data.[31] The strength of the existing evidence can be derived from the risk of type 1 and type 2 statistical errors; the percentages were set at 5%, 20%, and 10%, respectively, to result in a power of 80% and 90%. To regulate the risk of type 2 error, an extension of the Lan and DeMets alpha-spending function was used to adjust the threshold that represented what is denoted as futility boundaries.

RESULTS

Description of included and excluded studies

Database searches and title screening identified 29 new studies, and full-text publications were obtained for a full review. Of the 29 identified studies, 17[8-24] were included, with 1119 participants. These studies were added to the previous meta-analysis studies[6] to obtain a total of 31 studies,[28–30,32–42] and 2273 participants were included in the final analysis [Figure 1].

Figure 1.

Flowchart according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Flowchart of searches of included and excluded studies; BSCPB = Bilateral superficial cervical plexus block

BSCPB was performed before the surgical incision in the 27 studies,[8–24,28,32–38] eight of which were before the induction of general anaesthesia.[13–15,19,23,24,39,40] Two studies compared pre– and post–surgical incision BSCPB,[29,41] and two studied post-surgical incision BSCPB.[30,42] Most studies used standard induction techniques with an opiate, propofol, and muscle relaxant, while four used thiopental.[8,9,33,40] Two studies described a standardised induction protocol,[13,22] and two studies did not describe their technique.[23,24] Only one study used a purely regional technique.[36] Anaesthesia was maintained with an inhalational anaesthetic in 21 studies[8-12,14–16,18–21,28,30,32–34,38–40,42] with the addition of a remifentanil infusion in 3 of those.[9,11,12] Total intravenous anaesthesia was administered in five studies using a combination of propofol and remifentanil[17,29,35,37] and single agent propofol in one.[29]

Critical appraisal of study quality

Of the 31 studies used in this meta-analysis, 27 were RCTs[8–20,28–30,32–42], two were observational[21,22], and two were cohort studies.[23,24] Non-RCTs were reviewed carefully and included because they studied the defined outcomes and contributed relevant data. A sensitivity analysis was performed to assess the impact of including non-RCTs and demonstrated no difference in the outcomes. RCTs were evaluated and ranked according to their Jadad score.[26] Twenty RCTs had Jadad scores ≥3[8,10,11,13–16,18,19,28,30,32,34–38,40–42], and the remaining seven RCTs had scores ≤2.[9,12,17,20,29,33,39]

Primary outcome

For the primary outcome consisting of studies per participant 20/1037, the SMD; (95% CI) was − 1.81 (−2.37, −1.24) with P < 0.00001 and I² = 93% [Figure 2]. The sensitivity analysis performed did not alter the results. The exclusion of studies that included adjuvants did not change the overall results or heterogeneity.[29,34,42]

Figure 2.

Forrest Plot of Primary Outcome. Forrest Plot demonstrates the morphine or equivalent required between bilateral superficial cervical plexus block (BSCPB) and no block/saline. The Forrest Plot shows that the no block/saline placebo group require more opiate compared to the BSCPB group. LM=Landmark, USG=Ultrasound, Pr=Preoperative, Po=Postoperative, B=Bupivacaine, BC=Bupivacaine + clonidine, SD=Standard deviation, CI=Confidence Interval

For the point of injection subgroup analysis [Figure 3], there were six studies, consisting of 335 patients, with SMD (95% CI) = −3.36 (−4.90, −1.81), P < 0.0001, and I² = 96% for one-point injection technique compared to 11 studies, consisting of 557 patients, with SMD (95% CI) = −1.40 (-1.90, −0.90), P < 0.001, and I² = 85% for the three point injection technique. The two-point injection technique analysis only had three studies, consisting of 145 patients, with SMD (95% CI) = −1.73 (−3.80, 0.34), P = 0.10, and I² = 96%, thereby being insignificant in terms of technique. However, this might be due to the low number of studies or patients compared with the other groups. There were no observed differences between the subgroups (P = 0.06 and I² = 64.1%). The sensitivity analysis performed did not alter the results. The exclusion of studies that included adjuvants did not change the overall results.[29,34,42]

Figure 3.

Subgroup analysis forest plots; point of injection for BSCPB; ultrasound versus landmark technique for bilateral superficial cervical plexus block (BSCPB); comparison between saline or no block and BSCPB, showing morphine/equivalent requirement benefit of using BSCPB. LM=Landmark, USG=Ultrasound, Pr=Preoperative, Po=Postoperative, B=Bupivacaine, BC=Bupivacaine + clonidine. SD=Standard deviation, CI=Confidence Interval

For the above subgroup comparing saline versus no block/unspecified [Figure 3], there were studies per participant 7/368 with SMD (95% CI) = −1.51 (−2.02, −1.00) with P < 0.0001 and I² = 77% compared to studies per participants 13/669 with SMD (95% CI) = −2.12 (−2.99, −1.26) with P < 0.0001 and I² = 95%; sensitivity analysis performed did not alter the results. No subgroup differences were observed (P = 0.23 and I² = 31%). Excluding studies that used adjuvants did not alter the overall point estimate.[29,34,42] The mean difference in overall morphine consumption between the studies using saline versus no block was not different.

For the subgroups using the US-guided versus LM technique, there were studies per participant 7/395 in the US group compared to 13/642 in the LM group [Figure 3]. The respective SMDs (95% CI) were − 2.84 (−4.08, −1.59) with I² = 95% and − 1.43 (−2.03, −0.84) with I² = 91% and P < 0.00001 in both cases with no observed subgroup differences. The overall SMD (95% CI) = −1.81 (−2.37, −1.24), P > 0.00001 and I² = 93%. The sensitivity analysis performed did not alter the results. The exclusion of studies that used adjuvants did not change the overall results or heterogeneity.[29,34,42]

Secondary outcomes

There were studies per participant 16/853, and the SMD (95% CI) was 2.02 (1.39, 2.65), P was <0.0001, and I² was 93%; sensitivity analysis did not alter the results. Compared with our previous study, the mean duration of analgesia improved from 73 min to 178 min. However, with the exclusion of outliers, the mean difference in the duration of analgesia reduced from 178 min to 118 min, with no change in the direction of the overall point estimate or the P value. The exclusion of studies that included adjuvants did not alter the overall results.[29,34]

For the subgroup difference between saline and no/unspecified block versus BSCPB, the SMD (95% CI) for saline versus BSCPB was 1.84 (1.16, 2.51) with I² = 87% compared to no/unspecified block versus BSCPB of 2.45 (1.41, 3.49) with I² = 94%, respectively, with P < 0.0001 for both subgroups. The overall effect was 2.02 (1.39, 2.65) with P < 0.0001 and I² of 93%. No differences were observed between the two subgroups (P = 0.33 and I² = 0%). Sensitivity analysis and the exclusion of studies that included adjuvants did not alter the overall results.[29,34]

Using the pooled risk difference of −0.27, determined from the secondary outcome data, the calculated NNT was 3.7 compared to our previous 4.4 for using BSCPB on the rescue analgesia group. However, during subgroup analysis, in the group that received saline versus no block, the calculated NNT was 3.2 compared to 4.3, refuting our previous assumption that saline used as a placebo was more nociceptive. However, the differences observed could be due to the number of studies incorporated in our earlier meta-analysis.

In our previous meta-analysis, for a three-point technique, the calculated NNT was 4.8. However, for the two-point technique, it was 5.5, compared with NNT of 3.4 and 5.5, respectively, in our current analysis. This could be due to the difference in sample sizes; we noticed a difference in the NNT for the three-point technique. On the other hand, the one-point technique’s NNT was 2.7, but this should be treated with caution due to the sample size.

Intraoperative analgesic use exhibited a statistically significant reduction in the morphine equivalent used when the block was performed compared with the control group mean difference (MD) (95% CI) −3.15 (−4.62, −1.67) compared to our previous study MD (95% CI) −1.78 (−3.46, −0.10). Sensitivity analysis was performed by excluding studies that used adjuvants and did not alter the overall results or direction.[32,34] The observed differences could be ascribed to the number of participants included in the present study compared to our previous study (868 versus 343, respectively).

Additionally, intraoperative analgesic use was scrutinised for the timing of block administration. In the preoperative block group, there were studies per participant 13/707, compared to 2/161 in the postoperative group. Despite the overall significance (P = 0.001), the preoperative group demonstrated more benefit than the postoperative group (P = 0.002 versus P = 0.44). This contrasts with our previous study, and it may be due to the difference in the number of studies included in this update of our meta-analysis for the preoperative group (182 versus 707 participants).

For all the above outcome measures, where there were outliers in the results, a sensitivity analysis was conducted, excluding those outliers. In all the cases, the direction of the overall point estimates and P values did not change.

Analysis of bias and internal consistency

Meta-regression of the data for the year of publication, Jadad score, type and volume of local anaesthetic used, point of injection, US-guided versus LM technique, and saline versus no block established that there was no significant influence on the results. The risk of bias table also correlated well with the Jadad scoring, demonstrating no substantial differences [Figure 4].

Figure 4.

Risk of bias table. R=Ropivacaine, RC=Ropivacaine + clonidine, LM=Landmark, USG=Ultrasound, Pr=Preoperative, Po=Postoperative, B=Bupivacaine, BC=Vupivacaine + clonidine, L=Lignocaine

Egger’s regression and Begg and Mazumdar’s rank correlation demonstrated publication bias; however, we found no observed differences when examining the funnel plot for precision modelling. This was further proven by the “trim and fill” effect, where only three “studies” were missing on the left-hand side to be symmetric. Under the random effects model, the point estimate and 95% CI for the combined studies were − 1.87723 (−2.45785, −1.29660), whereas under the “trim and fill” effect, the imputed point estimate was − 2.38627 (−3.09618, −1.67636).

The “One study removed” analysis did not demonstrate any differences in the outcome measures for the moderators mentioned above. The cumulative analysis did not show any observable differences for the named moderators, with the relative weights of each study not varying enough to justify the impact of an independent moderator on overall outcomes. The cumulative analysis performed for studies in descending order of point estimate did not demonstrate any observed differences in the effect on the overall result.

Trial sequential analysis

In the trial sequential analysis (TSA), the necessary information size of 302 patients was achieved for 80% and 403 patients for 90% power. The z-line crossed the trial sequential monitoring boundary and the futility boundaries, suggesting firm evidence that showed the benefit of BSCPB for thyroidectomies [Figure 5]. However, having also penalised the z-values by the strength of the available evidence and the number of statistical tests called the law of the iterated logarithms, it was parallel to the z-curve at 80% and 90% power, showing no difference.

Figure 5.

Trial sequential analysis of primary outcome horizontal brown lines depict the conventional threshold for statistical significance at P = 0.05. The outer and inner angled lines represent the adjusted threshold for statistical significance and the futility boundaries for 80% and 90% power, respectively

DISCUSSION

The primary outcome data of this meta-analysis demonstrated a reduction in the total morphine equivalent consumption in the first 24 h following thyroid surgery in patients receiving BSCPB.

Opioid prescription is recognised as a contributing factor to the opioid crisis.[43] As such, the Faculty of Pain Medicine published guidelines in 2021 about multimodal analgesia during the perioperative period,[44] including procedure-specific analgesic techniques. This meta-analysis supports the inclusion of BSCPB for thyroidectomies. The opioid dose reduction was 8 mg, close to, but below, the minimum clinically significant difference in opioid consumption.[45]

Compared to our previous meta-analysis, the primary outcome demonstrated an NNT of 3.2 in favour of performing a BSCPB for analgesia in the perioperative period to reduce opioid consumption.

It should be noted that one study was an outlier in favour of reduced opioid requirements with BSCPB [Figure 2].[16] This was likely due to a difference in the surgical approach used (transoral), and when this study was removed, the overall difference in the primary outcome remained unchanged.

Subgroup analysis of the primary outcome included details of the BSCPB. Both US-guided and LM techniques were beneficial in providing analgesia (P < 0.0001). However, larger trials are needed to confirm that US guidance is superior or as good as the LM technique because the TSA (N = 395 patients) fell short of the required information size (RIS) of 697 patients for the US technique compared to said size (N = 642) for the LM technique which surpassed the required RIS of 223, both at 80% power.

Further subgroup analysis of three-point versus two-point injections suggested that a three-point injection was more likely to reduce the need for additional postoperative analgesia. However, the TSA showed that although the three-point injection was significant, it fell short of the RIS of 872 patients. Similarly, for the two-point injection, the sample size fell short of the RIS of 1300 patients, both powered at 80%. Therefore, the three-point technique is a better alternative to the two-point technique. However, more RCTs are required to ascertain this.[46]

The BSCPB offers superior analgesia compared to the control with no block or saline. This contrasts with the findings of a previous meta-analysis that stated that using saline as a placebo increased analgesic requirements over no block. This difference between analyses may be due to the increased sample size, particularly in the no-block control group (10/710 studies per participant versus 5/354 previously).[6]

This meta-analysis showed a statistically significant increase in time to when analgesia was first requested, with a mean difference of 178 min between patients having BSCPB and without BSCPB. Pain relief during recovery is an essential parameter for the quality of anaesthetic care, and the BSCPB improves this.[47] It may also be helpful in patients undergoing day-case thyroidectomies since postoperative analgesia is a barrier to same-day discharge.[48]

Postoperative pain scores in the first 24 h were reduced in patients who received BSCPB, reflected by reduced opioid consumption in that time frame, as were the intraoperative morphine requirement and incidence of rescue analgesia [Table 1]. Hence, we assume that BSCPB reduces the risk of PONV (OR = 0.62; P = 0.02) compared to placebo. Postoperative nausea rates were significantly high after thyroidectomy, further supporting the routine inclusion of BSCPB in the anaesthesia regime.[49]

Table 1.

Secondary outcome data

Secondary outcomes	No. of studies	No. of patients	SMD (CI)	P
VAS scores
T0	18	1231	−1.31 (−1.80, −0.83)	<0.0001
T4	12	796	−1.58 (−2.43, −0.73)	0.0003
T12	17	1125	−0.66 (−1.09, −0.24)	0.002
T24	21	1323	−0.72 (−1.07, −0.37)	<0.0001
Intraoperative morphine use (mg)	15	868	−0.75 (−1.19, −0.30)	0.001
Postoperative nausea and vomiting	19	1179	OR 0.62 (0.42, 0.92)	0.02
Postoperative rescue analgesia (PRA)	22	1526	OR 0.24 (0.15, 0.39)	<0.0001
PRA using saline	12	816	OR 0.22 (0.14, 0.34)	<0.0001
PRA using no block	10	710	OR 0.26 (0.10, 0.70)	<0.008
Point of injection technique	22	1526	OR 0.24 (0.15, 0.39)	<0.0001
One-point injection technique	2	131	OR 0.19 (0.09, 0.42)	<0.0001
Two-point injection technique	5	373	OR 0.36 (0.11, 1.25)	0.11
Three-point injection technique	15	1022	OR 0.21 (0.12, 0.40)	<0.0001

SMD=Standard mean difference; CI=Confidence intervals; VAS=Visual analogue scale; OR=Odds ratio; T=Time in h; PRA=Postoperative rescue analgesia

Comparison with previous meta-analyses and limitations

Compared to Warschkow et al.,[50] Mayhew et al.[6] demonstrated a reduction in the analgesic requirement of patients receiving a BSCPB. This update further shows a clear analgesic benefit of performing BSCPB for thyroid surgery, reducing morphine consumption in the postoperative period, improved NNT for rescue analgesia, and associated reduced PONV. Furthermore, the “trim and fill” effect and TSA support that our update was adequately powered to justify our findings.

Meta-regression, sensitivity analysis, “one study removed” analysis and cumulative analysis were performed to look for heterogeneity for the confounders, but we could not detect any; hence, we ascribe high heterogeneity to more intra-study variation than interstudy.

Despite the benefits of US-guided BSCPB and three-point versus two-point techniques, TSA has shown that more RCTs are needed to confirm this.

The British Association of Endocrine and Thyroid Surgeons (BAETS) have endorsed day-case thyroidectomies in suitably selected patients.[51] In support of broadening day-case surgery, Getting It Right First Time (GIRFT) advocates regional anaesthesia techniques and avoidance of agents contributing to PONV.[52] Therefore, utilising BSCPB in thyroid surgery will be well suited to optimising conditions for day-case surgery.

CONCLUSION

The BSCPB offers superior analgesia for thyroid surgery and significantly reduces the need for opioid analgesia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.