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International audience; Chronic postoperative pain exists in varying degrees for every type of surgery. An evaluation of the incidence, the typology and predictive factors of chronic pain was carried out at 3 and 6months after thyroidectomy. A prospective observational study, having included each of the patients prior to their thyroidectomy, was carried out over 12months. The patients used an 11-point numerical rating scale (NRS), a neuropathic pain screening questionnaire (DN4), an evaluation scale for anxiety and for the need for information related to anaesthesia and surgery (APAIS), a questionnaire describing pain (QDSA) and a questionnaire evaluating neuropathic pain (NPSI) before surgery and at three and six months later. Three hundred and four patients were included. The questionnaires were completed by 251 patients (57 males and 194 females) at 3 and 6months (82%). At 3months, 31 out of 251 (12%) patients mentioned a DN4≥3; at 6months, this rate dropped to 23 out of 251 (9%). The average intensity of chronic postoperative pain remained low to moderate. Levels of anxiety and the need for information were higher in patients with postoperative pain at 3 and 6months. In contrast, the number of intraoperative procedures using a bilateral superficial cervical plexus block (BSCPB) was lower in patients with DN4≥3. Multivariate analysis demonstrated that the type of anaesthesia procedure interfered with the risk of delayed pain after thyroidectomy. The presence of a DN4≥3 was nearly three-fold greater in patients without BSCPB (OR 2.647, CI=1.198-5.848).

ResumeIntroduction Un questionnaire d’auto-evaluation, l’Amsterdam Preoperative Anxiety and Information Scale (APAIS) traduit en francais a ete compare a un questionnaire de reference pour en valider l’utilisation comme outil de depistage et d’evaluation de l’anxiete et du besoin d’informations des patients en consultation d’anesthesie. Patients et methode Il s’agit d’une etude epidemiologique anonyme conduite avant consultation d’anesthesie. Les patients completaient un questionnaire comportant une version francaise de l’APAIS et l’inventaire d’anxiete de Spielberger (STAI). Une etude des niveaux de correlation entre les scores obtenus par chaque questionnaire a ete effectuee. Un seuil d’anxiete elevee a ete recherche. Resultats Ainsi 1800 questionnaires ont ete distribues, 1504 etaient exploitables. Les 100 premiers questionnaires ont confirme la validite interne du questionnaire APAIS. Les 1404 questionnaires suivants representaient 49,8 % d’hommes âges de 55,7 ± 15,7 ans et 50,2 % de femmes âgees de 50,8 ± 15,2 ans. Le coefficient de correlation (r) entre STAI-Etat et APAIS etait de 0,675 (p

Background Preoperative oral gabapentin has been shown to reduce postoperative pain. However, the effects of gabapentin as an adjunct to regional anesthesia is unclear and its effects on chronic pain remains unknown. In patients undergoing thyroidectomy, we investigated the effects on early and late (at 6 mo) postoperative pain of preoperative oral gabapentin as an adjunct to superficial cervical plexus block (SCPB). Method Fifty consecutive consenting patients were randomized to receive either 1200 mg of gabapentin (Group G) or placebo (Group P) 2 h preoperatively. Preoperative anxiety was assessed on a numeric scale from 0 to 6. A SCPB was performed after a standardized induction of anesthesia. The primary outcome, analgesic drug consumption, was assessed during the procedure and postoperatively in the postanesthesia care unit and after discharge to the ward. Over the first 24 h, pain levels at rest and during swallowing were measured on a numeric scale from 0 to 10. If the pain level was more than 4/10 at rest, patients received 1 g/6 h of IV paracetamol and/or 50 mg/6 h of IV tramadol as a rescue analgesic treatment in the interval. The day before operation and 6 mo after thyroidectomy, included patients were asked to answer a neuropathic pain diagnostic questionnaire. Results Population characteristics, preoperative anxiety, intraoperative drug consumption, procedure duration, and postoperative care unit stay were comparable in both groups. Analgesic consumption during the first 24 postoperative hours was similar in both groups (G: 3 [0-5] doses/24 h; P: 3 [1-5] doses/24 h; P = NS), as well as pain at rest (G: 2,2 [0.2-3.7]; P: 2 [0-6.3]; P = NS), and during swallowing (G: 2.8 [0.4-8.9]; P: 3 [1.4-6.3]; P = NS]). Eight patients had a diagnostic questionnaire score more than 3, 6 mo after operation versus 2 in preoperative period (P = 0.04). Such delayed neuropathic pain complaints were reported in seven patients receiving SCPB alone and only in one patient receiving both SCPB and preoperative adjunctive oral gabapentin. (P = 0.01). Conclusion Oral preoperative administration of gabapentin did not modify immediate pain management in thyroidectomy patients receiving SCPB, but prevented delayed neuropathic pain at 6 mo.

The use of regional anaesthesia in thyroid surgery remains controversial. This double-blind, randomized controlled study was conducted to evaluate the analgesic efficacy of bilateral superficial cervical plexus block (BSCPB) performed under general anaesthesia in patients undergoing total thyroidectomy.Eighty-seven consecutive consenting patients were randomized to receive a BSCPB with saline (Group P, n = 29), ropivacaine 0.487% (Group R, n = 29), or ropivacaine 0.487% plus clonidine 5 microg ml(-1) (Group RC, n = 29). Sufentanil was given during the intraoperative period for a 20% increase in arterial mean pressure or heart rate in a patient with a bispectral index between 40 and 60. All patients received 4 g of acetaminophen during the first 24 h after operation. The pain score was checked every 4 h and nefopam was given for pain score4 on a numeric pain scale.During surgery, the median sufentanil requirements were significantly reduced in Group RC compared with Groups R and P (0.32 vs 0.47 and 0.62 microg kg(-1); P0.0001). After surgery, the number of patients requiring nefopam within 24 h of surgery was significantly lower in Groups R and RC than in Group P (16 and 19 vs 25; P = 0.03). At post-anaesthetic care unit admission, median (range) pain scores were significantly lower in Groups R [3 (0-10)] and RC [3 (0-8)] than in Group P [5 (0-8), P = 0.03]. No major complications of BSCPB occurred during study.BSCPB with ropivacaine and clonidine improved intraoperative analgesia. BSCPB with ropivacaine or ropivaciane and clonidine was effective in reducing analgesic requirements after thyroid surgery.

Introduction L’administration de gabapentine en premedication a prouve son efficacite dans la prise en charge de la douleur aigue postoperatoire par son action anti-hyperalgesique. Peu d’etudes ont ete realisees avec pour objectif primaire la prevention de la douleur chronique. L’objectif de cette etude etait d’evaluer l’interet de la gabapentine en premedication sur la survenue de douleurs chroniques apres chirurgie thyroidienne. Materiel et methodes Apres accord du CPP Nord Ouest, 90 patients ont ete inclus entre avril 2012 et janvier 2013 dans une etude randomisee en double aveugle contre placebo realisee dans le service de chirurgie endocrinienne du CHRU de Lille. Les patients recevaient 2 heures avant le debut de l’intervention 1200 mg de gabapentine (G) ou un placebo (P). L’anesthesie generale etait standardisee. A 3 et 6 mois, les patients etaient contactes par courrier avec evaluation de la douleur chronique par le score de douleur neuropathique (DN2), une echelle numerique (0 : pas de douleur, 10 : douleur insupportable), le Questionnaire d’Evaluation de Douleur Neuropathique (QEDN) et le questionnaire de Saint-Antoine (QDSA). Le calcul des patients a ete effectue a partir de l’etude de Brogly [1] observant 17 % de douloureux chroniques a 6 mois avec une reduction de 85 % de l’incidence de ces douleurs avec la gabapentine. Donnees presentees en frequence (%) ou moyenne ± Deviation standard (DS). La comparaison intergroupe a ete realisee par un test de Student. p Resultats Cinq patients ont ete exclus en postoperatoire immediat pour violation du protocole. Les populations etaient comparables, en termes d’âge, de poids, de score ASA, de douleur preoperatoire, d’anxiete. A 3 mois, les reponses de 83 patients etaient analysees (G : 41 patients, P : 42 patients). 17 % des patients presentaient un score DN2 superieur ou egal a 3 (G : 6 patients soit 14,6 %, P : 8 patients soit 19 %) sans difference significative (p = 0,59). L’echelle numerique relevee etait en moyenne a 0,4 ± 0,93 dans le groupe G et 0,74 ± 1,38 dans le groupe P (p = NS). Une difference significative etait retrouvee pour les scores QDSA (G = 2,85 ± 5,02 et P = 3,29 ± 6,21 avec p = 0,04) et QEDN (G = 1,87 ± 3,09 vs P = 3,33 ± 3,96 avec p = 0,04). A 6 mois, les resultats de 81 patients etaient compares (G = 41 patients, P = 40 patients). Il etait mis en evidence 13,6 % de patients douloureux chroniques avec un score DN2 superieur ou egal a 3 sans difference significative entre les deux groupes (G : 4 patients soit 9,8 %, P : 7 patients soit 17,5 %, p = 0,35). L’echelle numerique, les scores QEDN et QDSA etaient comparables dans les deux groupes. Discussion Ce travail confirme la presence de douleurs residuelles neuropathiques de faible intensite a 3 et 6 mois apres thyroidectomie. Malgre une composante neuropathique plus marquee a 3 mois en l’absence de traitement, la gabapentine ne permettait pas de reduire significativement le nombre de patients douloureux chroniques a 6 mois.