Superficial and deep cervical plexus blocks versus patient-controlled analgesia in total laryngectomy; a randomized trial

Abstract

Introduction: The cervical plexus block (CPB) delivers analgesia for surgeries in the head and neck . Patient-controlled analgesia (PCA) has been utilized to enhance pain management. This study evaluates combined bilateral superficial and deep CPB versus PCA in postoperative pain management after total laryngectomy.

Materials and methods: Randimized two equal groups: the CPB group (n = 25), who received combined bilateral US-guided superficial and deep CBP, and the PCA group (n = 25), who received PCA. The primary outcome was postoperative visual analog scale (VAS) . The secondary outcomes were hemodynamic changes, fentanyl consumption, first rescue analgesia, hospital stay, and postoperative complications.

Results: Postoperative VAS scores (at 2 and 4 h) were greater in the PCA group compared to the CPB group, p values (0.031, 0.044), respectively. The results were comparable at 6 and 12 h; while at 18 and 24 h, they were elevated in the CPB. The intraoperative hemodynamics were elevated in the PCA group at skin incision and after 30 min. Fentanyl consumption, first rescue analgesia, hospital stay, and postoperative complications were comparable.

Conclusion: Ultrasound-guided combined bilateral superficial and deep CPB provided superior analgesia in the early postoperative period compared to PCA.

Clinical trial registration: https://pactr.samrc.ac.za PACTR202403682323400.

Keywords: Patient-controlled analgesia; deep cervical plexus block; head and neck surgeries; superficial cervical plexus block; total laryngectomy.