Among the most frequent operations in general and endocrine surgery are thyroid and major neck surgeries. Hemithyroidectomy, total thyroidectomy, completing thyroidectomy, neck dissections, and removal of different cervical tumours are some of these procedures [1]. These procedures are often carried out under general anaesthesia (GA), which offers sufficient airway control, patient comfort, and ideal surgical circumstances. However, especially in older patients and those with major comorbidities, general anaesthesia may be linked to problems such postoperative nausea and vomiting, airway-related issues, delayed recovery, higher analgesic doses, and prolonged hospital stay [2, 3].

For some neck procedures, regional anaesthetic methods are becoming more popular as alternatives to general anaesthesia. The cervical plexus block is one of these methods that has become a useful choice for analgesia and anaesthesia during thyroid and other cervical procedures. The anterolateral neck region receives sensory innervation from the cervical plexus, which arises from the anterior rami of the C1–C4 spinal neurones. By blocking these nerves, the surgical area can be effectively anaesthetised without experiencing many of the physiological side effects of general anaesthesia [4-6].

Cervical plexus blocks are now much safer and more effective thanks to the development of ultrasound guiding. Anatomical landmarks, nerve structures, fascial planes, blood vessels, and the distribution of local anaesthetic can all be directly seen using ultrasound. Precise needle placement is made easier by this real-time imaging, which also increases block success rates, lowers the need for local anaesthetic, and minimises problems such arterial puncture, nerve damage, and unintentional anaesthetic agent dissemination [7, 8].

When planning and carrying out ultrasound-guided cervical plexus blocks, radiological evaluation is crucial. Preoperative ultrasonography aids in the evaluation of cervical structures, the identification of anatomical differences, and the optimal positioning of blocks. Procedural success and patient safety may be enhanced by a correlation between radiological results and clinical outcomes [9].

Cervical plexus blocks in thyroid surgery have shown promising benefits in a number of studies; however, reported results are still influenced by differences in patient selection, surgical complexity, and anaesthetic procedures. To choose the best anaesthetic strategy for thyroid and major neck procedures, a comparison between general anaesthesia and ultrasound-guided cervical plexus block is still crucial [10, 11].

In patients undergoing thyroid and major neck operations, the current study compared the clinical effectiveness, postoperative results, and radiological correlation of ultrasound-guided cervical plexus block against general anaesthesia. The study sought to assess the effects of both anaesthetic procedures on perioperative haemodynamic stability, postoperative pain, analgesic requirements, complications, patient satisfaction, and hospital stay

This prospective comparative study was conducted in the Department of Radiology, Dhanalakshmi Srinivasan Medical College & Hospital, Siruvachur, Perambalur, Tamil Nadu, between September 2023 and August 2024. A total of 25 patients scheduled for thyroid and major neck surgeries were included in the study after obtaining written informed consent. Ethical approval was obtained from the Institutional Ethics Committee before commencement of the study. All patients underwent detailed clinical evaluation, routine laboratory investigations, anesthetic assessment, and preoperative ultrasonographic examination of the neck. Radiological findings were correlated with block success, perioperative outcomes, and surgical feasibility.

Methods:

Patient demographics, the reason for the procedure, the kind of surgery, the length of the procedure, intraoperative haemodynamic parameters, postoperative pain scores, the need for analgesics, complications, length of hospital stay, and patient satisfaction were all documented. Using a high-frequency linear ultrasound probe and aseptic measures, ultrasound-guided superficial and intermediate cervical plexus blocks were carried out in the cervical plexus block group. The Visual Analogue Scale (VAS) was used to measure postoperative pain at 2, 6, 12, and 24 hours after surgery. When the VAS was more than 4, rescue analgesia was given. Thyroid size, lesion features, cervical structural changes, and local anaesthetic spread patterns were among the radiological data that were recorded and connected with clinical outcomes and procedural success.

Inclusion Criteria:

• Patients aged 18 years and above.
• Patients undergoing major neck surgeries involving benign cervical masses or selected neck procedures.
• Patients willing to participate and provide written informed consent.

Exclusion Criteria:

• Patients refusing regional anesthesia or study participation.
• Known allergy or hypersensitivity to local anesthetic agents.
• Coagulation disorders or patients receiving anticoagulant therapy.
• Local infection at the proposed block site.
• Severe respiratory compromise requiring controlled ventilation.
• Emergency thyroid or neck surgeries.

Statistical Analysis:

We used SPSS version 26.0 to analyse the data that had been entered into Microsoft Excel. Continuous variables were expressed as mean ± standard deviation (SD), while categorical variables were expressed as frequencies and percentages. The Student's t-test was used to compare continuous variables such as operative duration, postoperative pain scores, analgesic consumption, and hospital stay between the two groups. The Chi-square test or Fisher's exact test was used to compare categorical variables including block success rate, complications, and patient satisfaction. Correlation analysis was performed to assess the relationship between radiological findings and clinical outcomes. A p-value less than 0.05 was 

A total of 25 patients undergoing thyroid and major neck surgeries were included in the study. Of these, 13 patients received Ultrasound-Guided Cervical Plexus Block (USG-CPB Group) and 12 patients underwent surgery under General Anesthesia (GA Group). Clinical outcomes, radiological findings, postoperative analgesia, and complications were analyzed and compared between the two groups.

Table 1: Baseline Demographic and Clinical Characteristics

Table 1 demonstrates that both groups were comparable regarding demographic and baseline clinical characteristics.

Table 2: Surgical Procedures Performed

Table 2 shows a similar distribution of surgical procedures between the two groups.

Table 3: Radiological Findings and Block Success

Table 3 demonstrates that ultrasound successfully identified cervical anatomical structures and facilitated effective block placement in the majority of patients.

Table 4: Intraoperative Hemodynamic Parameters

Table 4 shows better intraoperative hemodynamic stability in the USG-CPB group compared with the GA group.

Table 5. Postoperative Pain Scores (VAS)

Table 5 demonstrates significantly lower postoperative pain scores in the USG-CPB group during the first 12 postoperative hours.

Perioperative results in thyroid and major neck surgeries are significantly influenced by the anaesthetic strategy selected. Although general anaesthesia is still the standard method for these procedures, regional anaesthesia methods like cervical plexus block are becoming more and more popular due to their potential benefits, which include better postoperative analgesia, lower opioid use, and improved recovery [12, 13]. The current investigation showed positive clinical and radiological results linked to the regional anaesthesia strategy by comparing ultrasound-guided cervical plexus block (USG-CPB) with general anaesthesia (GA) [14, 15].

In the current study, 92.3% of patients had a successful surgical block using ultrasound-guided cervical plexus block; only one patient needed to be converted to general anaesthesia. This high success rate demonstrates how useful ultrasonography guiding is for increasing block accuracy and guaranteeing sufficient local anaesthetic deposition. In addition to reducing difficulties associated with blind injection procedures, direct visualisation of cervical fascial planes, vascular structures, and anaesthetic spread increases procedural success [16-18].

An essential component of the current study was radiological correlation. Accurate identification of cervical anatomical features was made possible by preoperative and procedural ultrasonography, which also identified anatomical changes in almost 25% of patients. The high block success rate was probably influenced by the real-time visualisation of local anaesthetic dissemination, which improved procedural precision. These results highlight the use of ultrasonography in contemporary regional anaesthesia practice as a diagnostic and therapeutic tool [19-21].

There are some limitations to the current investigation. The study was carried out at a single institution and had a rather limited sample size. Furthermore, cost-effectiveness assessments and long-term results were not assessed. To confirm these results and clarify the function of ultrasound-guided cervical plexus block in different neck surgical procedures, larger multicenter trials are needed [22-24].

Ultrasound-guided cervical plexus block provides a safe, effective, and consistent alternative to general anaesthesia for thyroid and major neck procedures, according to this study. High-success surgical anaesthesia, superior postoperative analgesia, lower analgesic requirements, greater haemodynamic stability, shorter hospital stay, and higher patient satisfaction were achieved. Ultrasound was used to visualise cervical architecture and local anaesthetic dissemination, improving block efficacy and safety. General anaesthesia is still effective, although ultrasound-guided cervical plexus block may be better for individuals who want to avoid airway manipulation and recover quickly. More large-scale research are needed to confirm these findings and increase its use in neck surgery.

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