Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jaime B. Hyman

Abstract

Purpose: To investigate the effect of the superficial cervical plexus block (SCPB) on the quality of recovery of patients undergoing thyroidectomy with an Enhanced Recovery After Surgery protocol

Methods: This double-blind randomized controlled trial recruited adult patients undergoing thyroidectomy to be randomized to receive pre-incisional bilateral SCPB with either 0.25% bupivacaine or saline. All enrolled participants completed a baseline Quality-of-Recovery 40 (QoR-40) survey prior to surgery, and another QoR-40 survey on postoperative day (POD) 1. Their electronic health records were reviewed to obtain information on secondary outcomes such as intraoperative analgesics administered, post-anesthesia care unit (PACU) duration of stay, incidence of nausea or vomiting in PACU, and post-operative opioid consumption in PACU and on POD 1. Differences in QoR-40 scores between baseline and POD 1 were assessed with paired t-test for global QoR-40 scores and also within QoR-40 dimensions.

Results: At the time of writing, 300 patients were screened for eligibility, of which 175 were contacted and 70 provided informed consent to participate. 1 participant was withdrawn by the principal investigator after consent was provided, resulting in 69 enrolled participants. There was no loss to follow up. Among all participants, there was a significant decrease in QoR-40 score from baseline to POD 1. (Baseline: 183.5 ± 15.4; POD 1: 174.3 ± 16.8; p < 0.001). There were also significant decreases in QoR-40 scores within the Physical Comfort (Baseline: 53.8 ± 5.37; POD 1: 52.4 ± 5.32; p < 0.05), Physical Independence (Baseline: 23.9 ± 1.98; POD 1: 20.4 ± 3.81; p < 0.001), and Pain (Baseline: 32.6 ± 3.23; POD 1: 28.8 ± 4.13; p < 0.001) dimensions. There were 5 adverse events, all of which were determined to be unrelated to the study interventions.

Conclusions: While full analysis cannot be performed at this time, interim analysis of the available data provides confidence for the study’s protocol and ability to complete recruitment for the desired sample size. Future directions are to complete study enrollment and full analysis of the data.

Comments

This is an Open Access Thesis.

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