Vol.:(0123456789) 1 3 European Archives of Oto-Rhino-Laryngology https://doi.org/10.1007/s00405-018-4933-4 HEAD AND NECK Bupivacaine wound infltration reduces postoperative pain and analgesic requirement after thyroid surgery Moncef Sellami 1  · Sarhan Feki 2  · Zied Triki 2  · Jamil Zghal 2  · Imen Zouche 2  · Boutheina Hammami 1  · Ilhem Charfeddine 1  · Mohamed Chaari 2  · Abdelmonem Ghorbel 1 Received: 16 February 2018 / Accepted: 9 March 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Background and objective We conducted a prospective double-blind randomized study assessing bupivacaine end-of-surgery wound infltration for pain relief in thyroid surgery. Methods Patients were randomly divided into two groups: Group S, local wound infltration with saline solution; Group B, bupivacaine 0.5% was administered. Pain perception was measured using visual analogue scale (VAS) during post-anaesthetic care unit (PACU) stay every 10 min and during the 24 postoperative hours admission at 2, 4, 6, 12, and 24 h after surgery. The total consumption of analgesics (morphine and nefopam) was recorded. Results Sixty patients were studied. The VAS scores were signifcantly lower in the bupivacaine administered group in the post-anaesthetic care unit (PACU) at 0, 10, 20, 30, 40, 50 and 60 min, and during the hospital stay at hours 6, 12, 18 and 24. The number of patients who required postoperative opioid rescue was signifcantly lower in group B. No patient in group B developed neurological or cardiological complications after infltration. Conclusion Bupivacaine application is efective in decreasing postoperative pain and analgesic requirement during the hospital stay for patients with thyroidectomy. Keywords Bupivacaine · Pain · Analgesia · Thyroidectomy Introduction Little attention has been focused on pain relief after thyroid- ectomy that can result in mild to moderate postoperative pain, especially within 24 h after surgery [1]. The major causes of post-thyroidectomy pain are wound incision, hyperextension of the neck, retraction of the wound edges during surgery and dissection [2]. Pain control after thyroid surgery enhances patients’ qual- ity of life and allows a quick return to normal daily activities [3]. Most of the patients require opioids that are prone to mul- tiple side efects such as respiratory depression, sedation nausea and vomiting. For these reasons, the use of non-opi- oid agents is actually recommended [4, 5]. A limited number of studies have shown a signifcant efect of locoregional anaesthesia in reducing postoperative pain and opioid requirements [6]. Bupivacaine is a long-acting local anaesthetic adminis- tered perioperatively via infltration, peripheral or epidural nerve block to efectively reduce postoperative pain [7]. Bupivacaine has been used for preoperative wound infl- tration, and intraoperative bilateral superficial cervical plexus block in thyroidectomy to prevent postoperative pain [3]. However, the beneft of local wound infltration with bupivacaine in decreasing postoperative pain is controversial [3, 6, 8]. We aimed to evaluate the impact of bupivacaine infltra- tion into the surgical feld after thyroidectomy on postopera- tive pain and analgesic requirement. * Moncef Sellami sellami_moncef@yahoo.fr 1 Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, 3029 Sfax, Tunisia 2 Department of Anesthesia, Habib Bourguiba University Hospital, Sfax, Tunisia