PARATHYROID SURGERY USING MONITORED ANESTHESIA CARE AS AN ALTERNATIVETO GENERAL-ANESTHESIA

BACKGROUND: Although there have been several reports in the literature describing a renewed interest in performing thyroid surgery under loc al anesthesia (LA), there has been little information regarding parath yroid surgery under local anesthesia, METHODS: We retrospectively revi ewed our experience of 49 LA parathyroid patients over a 9-year period at a single institution. A bilateral cervical block (C2-C3) was admin istered by a single surgeon using lidocaine and bupivacaine. RESULTS: The study included 39 females and 10 males with an average age of 62 y ears (range, 35-89 years). Every surgery was curative and the final pa thology revealed 46 parathyroid adenomas and 3 cases of parathyroid hy perplasia. Forty-seven percent of the patients were discharged within 6 hours of operation and the remaining patients had a 1.4-day average length of hospital stay. A group of age- and sex-matched controls who underwent parathyroid surgery using general anesthesia (GA) served as a control group with 27% of operations performed as outpatients and an average length of stay of 1.6 days. Return to work averaged 6 days fo r the LA group versus 8 days for the GA, In the LA group, there was on e instance of postoperative hemorrhage requiring reoperation and one i nstance of conversion to GA secondary to an inability to tolerate LA. There were no instances of recurrent laryngeal nerve injury or permane nt hypoparathyroidism in either group. CONCLUSIONS: These data suggest that experienced surgeons can perform parathyroid surgery safely and effectively using LA as an alternative to GA. (C) 1996 by Excerpta Med ica, Inc.