Regional anaesthesia in thyroid surgery

Thyroidectomy is usually performed under general anaesthesia with endotracheal intubation. Bilateral cervical plexus block has been occasionally used as sole anaesthesia technique for this operation in certain parts of world. Indications for regional anaesthesia elsewhere in the world are patient's preference and associated marked cardio-respiratory disease. This is the first report of thyroidectomy done solely under bilateral cervical plexus block in Pakistan. The patient had thyroid cancer and was medically compromised due to cardiac failure with ejection fraction of 25%. Bilateral cervical plexus block was performed to avoid the high risk with general anaesthesia. Total thyroidectomy was done while patient remained painfree during the procedure and top-up local anaesthetic infiltration was not required. Patient remained stable without any morbidity. Positive experience from this case indicates that regional anaesthesia with monitored anaesthesia care is safer than general anaesthesia in high risk patients and could be offered to selective thyroidectomy candidates.