Ropivacaine Local Infiltration for Pain Control After Thyroidectomy: A Systematic Review and Meta‐Analysis

TL;DR

This study finds that ropivacaine injections after thyroid surgery reduce early pain and opioid use but have no long-term benefits.

Contribution

A meta-analysis of RCTs reveals ropivacaine's short-term analgesic effect after thyroidectomy but no impact on longer-term outcomes.

Findings

Ropivacaine reduced pain severity for 1-2 hours post-surgery but not beyond.

Ropivacaine decreased opioid consumption without affecting hospital stay or patient satisfaction.

No difference in postoperative nausea and vomiting between groups.

Abstract

To evaluate the analgesic role of ropivacaine local infiltration in patients undergoing thyroidectomy.

PubMed, Google Scholar, CENTRAL, Scopus, and Web of Science.

A systematic review and meta‐analysis synthesizing evidence from randomized controlled trials (RCTs). Our specific endpoints include pain severity, total opioid analgesia consumption, patient satisfaction, length of hospital stay, postanesthesia care unit (PACU) length of stay, surgery duration, and the incidence of postoperative nausea and vomiting (PONV). Using Stata, we pooled dichotomous outcomes and continuous outcomes using risk ratio (RR) and standardized mean difference (SMD) or mean difference (MD), respectively, with a 95% confidence interval (CI).

Eight RCTs and 633 patients were included. Ropivacaine significantly decreased pain after 1 to 2 hours postoperatively (SMD: −1.40, 95% CI [−2.30, −0.51]). However, there was no difference between both groups after 4 hours (P = .11), 6 to 8 hours (P = .05), 16 to 18 hours (P = .10), and 24 hours (P = .37). Also, ropivacaine significantly decreased analgesia consumption (SMD: −0.75, 95% CI [−1.30, −0.20]), with no effect on surgery duration (P = .59), length of hospital stays (P = .32), patient satisfaction score (P = .25), and PACU length of stay (P = .25). Finally, there was no difference between both groups regarding the incidence of PONV (RR: 1.01, 95% CI [0.70, 1.45]).

Ropivacaine local infiltration after thyroidectomy significantly decreased pain for up to 1 to 2 hours and analgesia consumption compared to control, but with uncertain evidence. However, ropivacaine had no effect on pain from 4 to 24 hours, surgery duration, length of PACU stay, length of hospital stay, and patient satisfaction.

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