Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2022; 10(13): 4153-4160
Published online May 6, 2022. doi: 10.12998/wjcc.v10.i13.4153
Bilateral superficial cervical plexus block for parathyroidectomy during pregnancy: A case report
Jun-Young Chung, Yo Seob Lee, Seung Yeon Pyeon, Sang-Ah Han, Hyub Huh
Jun-Young Chung, Yo Seob Lee, Hyub Huh, Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, South Korea
Seung Yeon Pyeon, Department of Obstetrics & Gynecology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, South Korea
Sang-Ah Han, Department of Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, South Korea
Author contributions: Chung JY, Lee YS and Huh H were the patient’s anesthesiologists, performed bilateral superficial cervical plexus block and contributed to manuscript preparation; Pyeon SY was the patient’s Gynecologist, performed the analyses and interpretation and contributed to manuscript drafting; Han SA was the patient’s surgeon, performed parathyroidectomy and drafted the manuscript; Huh H reviewed and edited the manuscript; all authors issued the final approval for the version to be submitted.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest related to this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hyub Huh, MD, PhD, Associate Professor, Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, South Korea. clumania@gmail.com
Received: August 6, 2021
Peer-review started: August 6, 2021
First decision: January 10, 2022
Revised: January 21, 2022
Accepted: March 17, 2022
Article in press: March 17, 2022
Published online: May 6, 2022
Processing time: 266 Days and 19.8 Hours
Abstract
BACKGROUND

Primary hyperparathyroidism (PHPT) is the most common cause of pregnancy-related hypercalcemia. PHPT can cause maternal and fetal complications in pregnant women. General anesthesia for non-obstetric surgery in pregnant women is associated with maternal hazards and concerns regarding long-term neonatal neurocognitive effects. Surgical removal of the lesion in mid-pregnancy is currently the primary treatment option for pregnant patients with PHPT. However, the blood calcium concentration at which surgery should be considered remains under discussion due to the risk of miscarriage.

CASE SUMMARY

A 31-year-old nulliparous woman at 11 wk of gestation was admitted to our hospital for parathyroidectomy. The patient had a history of intrauterine fetal death with unknown etiology at 16 wk of gestation 1 year prior. Her blood test results showed that the serum calcium level was elevated to 12.9 mg/dL, and the parathyroid hormone level was elevated to 157 pg/mL. In a neck ultrasound, it revealed a 0.8 cm × 1.5 cm sized oval, hypoechoic mass in the upper posterior of the left thyroid gland, which was compatible with parathyroid adenoma. Superficial cervical plexus block (SCPB) for parathyroidectomy was performed. After surgery, the obstetrician checked the status of the fetus, and there were no abnormal signs. Since then her calcium level returned to normal values after one week of surgery and a healthy male neonate of 2910 g was delivered vaginally at 38 wk of gestation.

CONCLUSION

Our case suggests that SCPB can be an anesthetic option for parathyroidectomy during the first trimester of pregnancy.

Keywords: Bilateral superficial cervical plexus block; Hypercalcemia; Parathyroid adenoma; Parathyroidectomy; Pregnancy; Case report

Core Tip: Pregnant women undergoing general anesthesia for non-obstetric surgery have risks of maternal hazards. In addition, the surgery might affect the long-term development of the fetus in early pregnancy and cause premature birth in late pregnancy. Pregnant patient with severe primary hyperparathyroidism (PHPT), such as our case, should have their calcium concentration lowered before surgery. Surgical removal of the lesion in mid-pregnancy is the treatment-of-choice in PHPT. However, in case of persisting hypercalcemia despite of conservative treatment, superficial cervical plexus block can be an anesthetic option for parathyroidectomy during the first trimester of pregnancy.