Pain Outcomes and Predictors in Transoral Vestibular Thyroidectomy

Abstract

Purpose The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is an emerging minimally invasive alternative to conventional open thyroidectomy; however, postoperative pain data remain limited. Methods This retrospective study aimed to determine the incidence of moderate to severe pain in the post-anesthesia care unit (PACU) after TOETVA and to identify associated factors. Design We retrospectively reviewed adult patients with thyroid gland disease who underwent TOETVA at a tertiary and a private hospital in Thailand between March 2017 and December 2023. Moderate to severe pain in the PACU was assessed using the numeric rating scale (NRS). Patients were classified into two groups: no to mild pain (NRS 0-3) and moderate to severe pain (NRS 4-10 or receipt of rescue medication). Results Of the 125 patients who underwent TOETVA, 74 (59.2%; 95% CI 50.4%-67.4%) experienced moderate to severe pain in the PACU. No statistically significant differences in demographic data were found between the groups. Multivariable logistic regression showed that intraoperative nefopam was associated with reduced moderate to severe pain in the PACU (adjusted odds ratio, 0.08; 95% CI 0.01-0.75; p = .03). Conclusions In this cohort, 59.2% of patients who underwent TOETVA experienced moderate to severe pain. Intraoperative nefopam was associated with lower pain scores, suggesting it may be a beneficial analgesic adjunct for TOETVA. Clinical implicaiton The high incidence of moderate to severe postoperative pain in patients undergoing TOETVA highlights the need for more effective analgesic protocols. The use of intraoperative nefopam should be considered as a beneficial adjunct to reduce early postoperative pain in the PACU.