Regional anesthesia for awake surgical excision of a voluminous parathyroid adenoma

Surgical excision under general anesthesia (GA) remains the standard of care for parathyroid adenomas (PAs). However, regional anesthesia (RA) techniques may offer significant advantages in patients with elevated perioperative risk. This case report presents the successful resection of a PA in a 59-year-old male with multiple comorbidities, including hypertensive heart disease, obesity, and obstructive sleep apnea, performed under RA.

The patient underwent surgery utilizing an ultrasound-guided cervical plexus block in conjunction with local infiltration anesthesia. A single-puncture technique was employed to administer a combination of superficial and intermediate cervical plexus blocks using a levobupivacaine-dexmedetomidine solution. Additionally, ultrasound-guided local infiltration was performed at the incision site to augment intraoperative analgesia. Throughout the 45-minute procedure, the patient maintained stable hemodynamic parameters and spontaneous ventilation, with no need for airway instrumentation. The analgesic regimen provided excellent intraoperative and postoperative pain control, with the patient reporting minimal discomfort and no postoperative nausea or vomiting.  This case underscores the potential of regional anesthesia as a safe and effective alternative to general anesthesia in selected patients undergoing parathyroid surgery. RA can provide superior perioperative analgesia, reduce opioid consumption, and mitigate the risks associated with airway manipulation, particularly in individuals with significant cardiorespiratory comorbidities.