BABA endoscopic thyroidectomy, Incidence, Neuropathic pain, NRS, Observational study
Citation Information :
Kumar S, Khuba S, Chand G, Singh P, Gautam S, Agarwal A, Mishra P. Study for the Incidence of Postsurgical Neuropathic Pain Following Bilateral Axillo-breast Approach of Endoscopic Thyroidectomy: A Pilot Observational, Prospective Study. World J Endoc Surg 2022; 14 (1):1-6.
Aim: To determine the incidence of postsurgical neuropathic pain following the bilateral axillo-breast approach (BABA) approach of endoscopic thyroidectomy, a minimally invasive approach for thyroid surgeries.
Materials and methods: Fifteen patients undergoing BABA endoscopic thyroidectomy were followed at 15 days, 1 month, and 3 months of surgery. Incidence, character, and severity of neuropathic pain following surgery were assessed. The area of distribution of the pain was also noted.
Results: The incidences of neuropathic pain following BABA endoscopic thyroidectomy were 73.3%, 40%, and 20%, respectively after 15 days, 30 days, and 3 months of surgery. The median (range) NRS pain scores were 4 (3, 5), 2 (2, 3), and 1 (0, 2) on day 15, day 30, and 3 months, respectively. The distribution of pain was mainly in the anterior aspect of the neck (66.67%) and the upper part of the chest (66.67%). The commonest neuropathic pain features were pin pricking, brush allodynia, tingling, and numbness in the involved area.
Conclusion: Despite the enormous technical and surgical benefits of the BABA approach for endoscopic thyroidectomy, the high incidence of both acute and chronic neuropathic pain following surgery needs consideration.
Clinical significance: To draw attention to the alarming complication of neuropathic pain after BABA endoscopic thyroidectomy, which should be addressed to decrease patient morbidity.
Merskey H, Bogduk H, eds. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Seattle: IASP Press 1994.
Martinez V, Baudic S, Fletcher D. Douleurs chroniques postchirurgicales. Ann Fr Anesth Reanim 2013;32(6):422–435. DOI: 10.1016/j.annfar.2013.04.012
Gagner M, Inabnet WB 3rd. Endoscopic thyroidectomy for solitary thyroid nodules. Thyroid 2001;11(2):161–163. DOI: 10.1089/105072501300042848
Choe JH, Kim SW, Chung KW, et al. Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg 2007;31(3): 601–606. DOI: 10.1007/s00268-006-0481-y
McCaffery, Beebe A. Pain: clinical manual for nursing practice, Mosby St. Louis, MO. 1989.
Bouhassira D, Attal N, Alchaar H, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005;114(1–2):29–36. DOI: 10.1016/j.pain.2004.12.010
Li H, Li J. Thyroid disorders in women. Minerva Med 2015;106(2): 109–114. PMID: 25668600.
Chong KH, Wu MH, Lai CW. Comparison of surgical outcome between conventional open thyroidectomy and endoscopic thyroidectomy through axillo-breast approach. Ci Ji Yi Xue Za Zhi 2020;32(3):286–290. DOI: 10.4103/tcmj.tcmj_109_19
Ikeda Y, Takami H, Sasaki Y, et al. Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg 2003;196(2):189–195. DOI: 10.1016/S1072-7515(02)01665-4
Kim SY, Jeong JJ, Chung WY, et al. Perioperative administration of pregabalin for pain after robot-assisted endoscopic thyroidectomy: a randomized clinical trial. Surg Endosc 2010;24(11):2776–2781. DOI: 10.1007/s00464-010-1045-7
Ranvier GF, Meknat A, Guevara DE, et al. International multi-institutional experience with the transoral endoscopic thyroidectomy vestibular approach. J Laparoendosc Adv Surg Tech A 2020;30(3): 278–283. DOI: 10.1089/lap.2019.0645
Kim HY, Chai YJ, Dionigi G, et al. Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients. Surg Endosc 2018;32(2):688–694. DOI: 10.1007/s00464-017-5724-5
Duehmke RM, Derry S, Wiffen PJ, et al. Tramadol for neuropathic pain in adults. Cochrane Database Syst Rev 2017;6(6):CD003726. DOI: 10.1002/14651858.cd003726.pub4
Subedi M, Bajaj S, Kumar MS, et al. An overview of tramadol and its usage in pain management and future perspective. Biomed Pharmacother 2019;111:443–451. DOI: 10.1016/j.biopha.2018.12.085
Kang JB, Kim EY, Park YL, et al. A comparison of postoperative pain after conventional open thyroidectomy and single-incision, gasless, endoscopic transaxillary thyroidectomy: a single institute prospective study. Ann Surg Treat Res 2017;92(1):9–14. DOI: 10.4174/astr.2017.92.1.9