Fascial plane blocks and conscious sedation for a patient undergoing minimally invasive hemithyroidectomy

Abstract

Fascial plane blocks for thoracic and neck surgery provide not only peri-operative analgesia but also serve as an effective alternative to general anaesthesia when combined with procedural sedation. Hemithyroidectomies are commonly performed by an open technique involving a transverse neck incision. Minimally invasive endoscopic approaches can offer cosmetic benefits, quicker recovery and reduced need for analgesia. Avoiding general anaesthesia may reduce complications, such as pulmonary atelectasis and cardiovascular instability, which may be of benefit to patients at increased risk. We describe the use of a combination of fascial plane blocks (superficial cervical plexus block, clavipectoral fascia plane block, interpectoral plane block and pectoserratus plane block) and dexmedetomidine sedation for a 65-year-old patient who had previously experienced accidental awareness under general anaesthesia and was very keen to avoid another general anaesthetic. The procedure was uneventful, with minimal bleeding and stable respiratory and haemodynamic parameters throughout. The patient was extremely satisfied with the anaesthetic technique and the cosmetic results of the surgery. We propose that fascial plane blocks along with dexmedetomidine sedation can be an effective alternative to general anaesthesia for endoscopic hemithyroidectomy in selected patients.