S. SEN1, K. REKA2, A. J. CHERIAN1, P. RAMAKANT1, P. M. JACOB1, D. T. ABRAHAM1 2CMC HOSPITAL,BIOSTATISTICS,VELLORE, TAMIL NADU, India 1CMC HOSPITAL,ENDOCRINE SURGERY,VELLORE, TAMIL NADU, India
Introduction:
Focused parathyroidectomy is treatment of choice in PHPT (Primary hyperparathyroidism) due to single gland adenoma in patients with concordant imaging on parathyroid scintigraphy and ultrasound. To avoid delays due to lack of anaesthesia time, this can be performed under local anaesthesia (LA) in a select group of patients
This study was done to evaluate the effectiveness of focused parathyroidectomy under local anaesthesia and mild sedation administered and monitored by surgeon
Methods:
We conducted a prospective observational study of all patients undergoing focused parathyroidectomy under local anesthesia at our institution. All consecutive patients with PHPT from Oct 2015 to July 2016, planned for the same, were evaluated for suitability to perform this procedure under LA after institutional ethics approval. If feasible, they were consented and outcomes were noted.
The study evaluated the following outcomes:
Primary outcomes:Biochemical cure – corrected calcium and PTH in immediate post operative period
Secondary outcomes:Complications – hematoma, nerve injury, hypocalcaemia, failed exploration, wound infection; Scar size; Intra-operative and Post-operative pain – visual analogue score; Post-operative nausea and vomiting; Requirement of analgesia – local anaesthetic used , fentanyl, midazolam dosages; Total duration of procedure – operating time;Overall patient satisfaction- patient satisfaction with anaesthesia, surgery
Results:
24/46 underwent the procedure under LA with mild sedation.
All patients had a biochemical cure in the immediate post operative period. 1/ 24 patient was converted to General Anaesthesia (GA) due to bleeding. 1/ 24 patient had voice change post operatively, 14 /24 patients had hypocalcaemia postoperatively requiring oral or intravenous calcium.
The mean length of scar was 4.38 + 0.17 cm. The mean gland weight and maximum dimension were 2502.08 + 466 mg and 2.383+ 0.20 cm respectively. On Visual Analog Score (VAS), the mean score was 2.67+ 0.339and 1.83+ 0.197 in 1st and 2nd post operative day respectively.
Table 1 shows the mean of analgesic requirement
The mean ‘operating’ times was 53.33+ 3.453 minutes.
The mean satisfaction score (1-5, 5 being most satisfied) with LA and surgery were 4.71+ 0.112 and 4.88 +0.069 respectively
Conclusion:
Focused parathyroidectomy under LA could be monitored and performed safely by a surgeon ensuring both biochemical cure and adequate patient satisfaction for a select group of patients
