Regional anesthesia for awake surgical excision of a voluminous parathyroid adenoma: a case report

Surgical excision under general anesthesia (GA) remains the standard treatment for parathyroid adenomas (PAs), but regional anesthesia (RA) approaches offer advantages for high-risk patients. This case report describes successful PA resection in a 59-year-old male with multiple comorbidities (hypertensive heart disease, obesity, obstructive sleep apnea) using ultrasound-guided cervical plexus block and local infiltration anesthesia. The procedure employed an ultrasound-guided single-puncture technique combining superficial and intermediate cervical plexus blocks with levobupivacaine-dexmedetomidine solution, supplemented by ultrasound-guided local infiltration at the surgical incision site. The patient maintained stable vital signs and spontaneous breathing with excellent analgesia during the entire procedure, which lasted 45 minutes, reporting outstanding postoperative analgesia. This case demonstrates RA’s efficacy for parathyroid surgery, providing optimal perioperative pain control while avoiding airway manipulation, reducing opioid requirements, and minimizing postoperative nausea and vomiting – representing a viable alternative to GA for patients with cardiorespiratory comorbidities.