Use of the On-Q system for pain management after robot-assisted endoscopic transaxillary thyroidectomy

Abstract

Purpose: The robot-assisted transaxillary approach to thyroid surgery is a novel method that has recently been used in hopes of improving patient safety and cosmetic outcomes. We evaluated post-operative pain after robot-assisted endoscopic transaxillary thyroid surgery and pain relief using a continuous wound perfusion system with local anesthetics.Materials and Methods: In a control group of 25 female patients who underwent robot-assisted endoscopic transaxillary thyroidectomy, post-operative pain scores and characteristics as well as analgesic use were monitored. 50 female patients undergoing robot-assisted endoscopic transaxillary thyroidectomy were given an On-Q system, and were randomly assigned to receive one of two different local anesthetic doses: group I (0.25% Ropivacaine, n=25), group II (0.375% Ropivacaine, n=25). Pain score, pain site, analgesic requirements and side effects in each group were recorded during 48h after surgery.Results: Post-operative pain scores and analgesic demand were lower in the On-Q groups than in the control group. No difference was found between group I and group II. Until 6-12h after surgery, pain was mainly located in the axilla, while after 6-12h the primary location of pain had a tendency to move to the neck. Pain scores gradually decreased with time in all patients.Conclusions: Patients who underwent robot-assisted endoscopic transaxillary thyroidectomy with an On-Q system injecting 0.25% ropivacaine had a low pain score, showing the effectiveness of the system. As a potential pain blocker, continuous wound perfusion with the On-Q system attenuates side effects. This could lead to shortened hospital stays after robot-assisted endoscopic transaxillary thyroidectomy.