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Case Report

Awake Parathyroidectomy in a Patient with Aortic Stenosis with Renal Failure: Role of Regional Plexus Block, A Viable Alternative to General Anaesthesia

M.P. Nath** , Samit Parua* , A.R. Khakhlari** , M.P. Nath**

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Indian Journal of Anesthesia and Analgesia 3(1):p 51-55, Jan-Apr 2016. | DOI: DOI : https://dx.doi.org/10.21088/ijaa.2349.8471.3116.9

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Abstract

Introduction: Primary hyperparathyroidism is a hypercalcemic state due to excessive secretion of parathyroid hormone (PTH). The most common cause being single parathyroid adenoma. Majority of these cases detected by screening of serum calcium concentration, are older individuals who present with  associated  comorbidities. Few patients may present with Hyperparathyroid crisis a serious and potentially life threatening complication ofsevere primary Hyperparathyroidism. Parathyroidectomy leads to the cure of the disease. Parathy-roidectomy for localized adenomas are usually performed under general anaesthesia, however cervical plexus block is also a good alternative. Case Report: We describe the anaesthetic management of a 72 years old, ASA III MP IIImale patient who underwent parathyroid adenoma (right) excision under combined superficial and deep cervical plexus block. Patient was a diagnosed case of primary hyperparathyroidism. Other comorbidities beingmoderate aortic stenosis,ischaemic heart disease, chronic kidney disease, hypertension and cervical spondylosis. Patient was having regular episodes of parathyroid crisis and had to be operated upon, but the patients’ medical condition contradicted general anaesthesia so patient was operated under right sided combined superficial and deep cervical plexus block with awake sedation, resulting in excellent anaesthesia of the operation site, stable haemodynamics, adequate intraoperative analgesia withreduced postoperative analgesic requirement. Discussion: Cervical plexus blocks the motor and sensory nerves originating from C2 to C4 nerve roots. It has been shown to be safe for thyroid and parathyroid surgeries, with cure rates equivalent to general anaesthesia.Parathyroidectomies done under regional anaesthesia significantly reduced post-operative pain, nausea, and vomiting.However the studies available till now on regional versus general anaesthetic approach for parathyroidectomies do not yield definitive information, regarding which technique is superior. Hypercalcemia along with associated muscular weakness was another reason why cervical plexus block was preferred in our patient. Conclusion: Thus cervical plexus block may be used as an alternative to general anaesthesia for thyroid and parathyroid surgeries, especially in patients with multiple co morbidities in whom administering a general anaesthesia may be problematic.

Keywords: Hyperparathy-roidism; Aortic Stenosis; Hyperparathyroid Crisis; Cervical Plexus Block.

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DOI: DOI : https://dx.doi.org/10.21088/ijaa.2349.8471.3116.9

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