Background: Thyroidectomy is a commonly performed surgical procedure in the department of Surgical Endocrinology. It is associated with a significant incidence of post operative pain and nausea & vomiting (PONV). Opioid analgesic use in the intra operative and post operative period is one of the causes for PONV, which is one of the most common and distressing symptom in our experience. Bilateral superficial cervical plexus block has been used in thyroidectomy for its analgesic effects and many studies show reduced pain and opioid requirement in these patients. However, it is unclear if this translates into a decrease in the incidence of PONV as all previous studies have routinely used opioid analgesics in the post operative period Objectives: We prospectively recruited 100 patients who underwent thyroidectomy (hemi, completion, total thyroidectomy) without neck dissection. The patients were randomised to receive either bilateral superficial cervical plexus block (Intervention group n = 50) using 20 ml of 0.25% bupivacaine (10 ml on each side) or no block (no intervention, n = 50), after introduction of general anaesthesia. The post operative pain and PONV scores were assessed for all the patients during the first 48 hours after surgery and it was compared between the two groups. Methods: The study was a randomised controlled trial between cervical plexus block and no intervention. Patients undergoing thyroidectomy with no lateral neck dissection were enrolled. A total of 100 patients were enrolled in the study with 50 in each arm. The end points studied were pain scores and PONV scores in the two groups. These patients were followed up in the ward for the next 48 hours with pain scores and PONV scores. Results: The demographic and clinical characteristics were similar in both the groups. The pain and PONV scores in both groups showed a decline with time. However, there was no statistically significant difference between the two groups. Bilateral superficial cervical plexus block before thyroidectomy did not significantly decrease the post operative pain scores or the incidence of post operative nausea and vomiting. From our study results, we do not recommend its routine use in thyroid surgery for prevention of pain or post operative nausea and vomiting.

Summary Multinodular Goitre is a common condition in India. It often requires surgical removal either due to mass effect or cosmesis. Association of Thymic mass with Multinodular goitre is not reported elsewhere. We report a case of Multinodular goiter with associated Thymoma in a lady aged 61 years. She underwent near total thyroidectomy with sternotomy for thymectomy in same sitting.

Introduction: Tracheo-laryngeal resections in locally advanced thyroid cancer involve adequate anatomical knowledge and surgical skills to have improved outcomes and minimal morbidity. Surgical options range from aggressive resections with end to end anastomosis to various conservative methods. Benefits and improved outcomes with each surgical technique need to be weighed against the morbidity caused by them. Aim and method: To review literature data available on tracheo-laryngeal resections in thyroid cancer and analyze the outcomes of surgery in terms of extent of surgery, adjuvant therapies, morbidity, recurrence rates, survival benefits and mortality. Result and Conclusion: Major tracheo-laryngeal resections are safe, less morbid, improve survival rates and have lesser recurrence rates compared to conservative methods. Long term prospective studies are needed to have a higher level of evidence for such recommendations.