Superficial Cervical Plexus Block and Quality of Recovery after Thyroidectomy: A Randomized Clinical Trial

Background: – Whether adding a bilateral superficial cervical plexus block to a thyroidectomy enhanced recovery pathway improves postoperative quality of recovery remains uncertain. Methods: – In a single-center prospective, randomized, double-blind, placebo-controlled trial in adults undergoing thyroidectomy with general anesthesia, participants were randomized to bilateral superficial cervical plexus blocks with 0.25% bupivacaine or saline. All participants received multimodal analgesia with dexamethasone, acetaminophen, non-steroidal anti-inflammatory drugs, and incisional local anesthetic. The primary outcome was quality of recovery (QoR), measured by the QoR-40 survey, on postoperative day (POD) 1. Secondary outcomes included the need for rescue opioid, total opioid consumption, nausea, vomiting, antiemetic administration, and length of stay in the postanesthesia care unit (PACU), and opioid use on POD 1. Results: – 160 participants were randomized to receive a superficial cervical plexus block with bupivacaine 0.25% (n = 78) or saline (n = 82). On POD 1, mean QoR-40 scores were 174 (95% CI 170 to 178) for bupivacaine and 173 (169 to 177) for saline. The adjusted mean difference between bupivacaine versus saline was 0.91 (95% CI, -3.57 to 5.40; p=0.688). There were no significant between-group differences in the need for opioids in the PACU or on POD 1, nausea, vomiting, or PACU length of stay. However, the total amount of opioid administered in the PACU was lower in the bupivacaine group (median [IQR], 0 [0, 8]) compared with the saline group (2 [0, 20]; Hodges-Lehmann location shift, 0 MME; 95% CI, −4 to 0; p=0.017), and fewer participants in the bupivacaine group received rescue antiemetics [3 (3.8%) vs. 13 (16%); difference, −12%; 95% CI, −22% to −1.8%; p=0.011]. Conclusions: – Bilateral superficial cervical plexus blocks did not improve quality of recovery after thyroidectomy when added to a multimodal analgesic regimen including dexamethasone, acetaminophen, NSAIDs, and incisional local anesthetic, but were associated with lower total PACU opioid consumption. Trial Registration: – ClinicalTrials.gov NCT06002152.