To Evaluate the Efficacy of Dexamethasone as an Adjuvant in USG Guided Bilateral Superficial Cervical Plexus Block Using 0.25% Bupivacaine in PatientsUndergoing Thyroid Surgery

Introduction: During thyroidectomy we want to maintain intraoperative hemodynamic stability, postoperative analgesia and reduce postoperative complications. To serve the purpose we can use opioids, NSAIDs, paracetamol, Tramadol and local anaesthetic infiltration with or without adjuvant in fascial planes of the neck. Ultrasound‑guided block remains as a reliable tool for performing a cervical plexus block, provides faster onset and longer duration of the block, reduces the performance time, and reduces the complications in addition to reduced local anaesthesia requirement. Perineural use of Dexamethasone prolongs analgesic duration of peripheral nerve blocks, reduces postoperative nausea and/or vomiting (PONV) and reduces general anaesthetics, shorten the hospital stay as well as reduce the severity of pain in the first day postoperatively. The present study was conducted to compare the effect of dexamethasone in the superficial cervical plexus block in thyroid surgeries by its effect on nausea, pain scores, vomiting, and hospital stay. Methods: The present interventional study was conducted in a tertiary care center involving cases of ASA grade I and II patients undergoing thyroidectomy from December 2022 to June 2024. The patients were randomly divided into 2 groups using computer generated random numbers. One group received 1ml dexamethasone (4mg) + 19ml 0.25% Bupivacaine in BSCPB (A Group), and the other group received 1ml Normal saline + 19ml 0.25% Bupivacaine in BSCPB (B Group). After the induction of general anaesthesia, superficial cervical plexus blocks was administered bilaterally before the surgical incision. Results: Mean heart rate and mean Spo2 at preoperative baseline, after induction, after block 0 to 180 min. did not differ between two groups. Mean systolic blood pressure, mean diastolic blood pressure and mean arterial blood pressure at preoperative baseline, after induction, after block 0 to 180 min. differed significantly between two groups with more marked rise in group B. The mean VAS score differed significantly between group A and group B (p>0.05) with high VAS scores in group B. Mean duration of post operative analgesia (12.3 + 1.9 hrs. in group A vs 8.4 + 1.1 hrs. in group B) differed significantly between these two groups with longer duration of post operative analgesia in group A (p=0.01). Two groups did not differ significantly in postoperative complications. Conclusions: We conclude that the hemodynamic parameters are more stable with group A (Dexamethasone adjuvant group). Addition of dexamethasone prolonged duration of analgesia, reduced pain intensity, duration, and requirement of rescue analgesia without significant increase in post operative complications.