ULTRASOUND GUIDED BILATERAL INTERMEDIATE CERVICAL PLEXUS BLOCK AS AN ALTERNATIVE TO GENERAL ANAESTHESIA IN PATIENT FOR TOTAL THYROIDECTOMY WITH DIFFICULT AIRWAY: CASE SERIES.

Abstract

Background: Total thyroidectomy is traditionally performed under general anaesthesia, which can be challenging in patients with difficult airways. This case series explores the use of ultrasound-guided bilateral intermediate cervical plexus block (US-BICPB) as an alternative anaesthetic technique for patients undergoing total thyroidectomy with potential or actual difficult intubation. Methods: Four patients scheduled for total thyroidectomy with identified difficult airway management were included. US-BICPB was performed using a mixture of 0.5% bupivacaine and 1% lidocaine with adrenaline. Sensory block was assessed, and patients were monitored for hemodynamic stability, pain scores, and adverse events. Results: All four patients successfully underwent total thyroidectomy under USBICPB without conversion to general anaesthesia. Patients remained hemodynamically stable throughout the procedures, with pain scores remaining at 2 or below on the Numerical Rating Scale (NRS) for several hours postoperatively. No major complications were reported. Patients expressed satisfaction with the technique and were discharged within 2-3 days post-surgery. Conclusion: US-BICPB appears to be an effective and safe alternative anaesthetic technique for total thyroidectomy in patients with difficult airways. This approach may offer advantages in terms of airway management, postoperative pain control and patient satisfaction. Further studies with larger sample sizes are needed to confirm these findings and establish optimal protocols for patient selection and block administration.