The prevention and treatment of post-operative pain is a long-debated issue which is attracting more and more attention. Thyroidectomy is associated both to post-operative pain located in the surgical wound and in the posterior neck. In particular, in 2015 Han et al reported that 80% of patients who underwent thyroid surgery complain about posterior neck pain post-operatively. Posterior neck pain is probably due to the position of the patient on the operative bed with the neck hyperextended (8). Indeed, the operating table is equipped with a manually adjustable headrest to calibrate neck extension keeping the head in a stable position.
Post-operative neck pain, a distinct entity from surgical pain located at the wound, occurs commonly after thyroidectomy and is treated with analgesics. As wound pain occurs immediately after surgery it usually lasts for at least 48 hours (9).
In our study, the inclination angle of the hyperextension on the operatory bed was significantly associated to post-operative neck pain (p < 0.001; beta 0.270), showing a direct correlation. This aspect means that it is likely that as the angle of inclination of the neck increases, post-operative pain may increase. In our analysis, no other parameter resulted correlated to post-operative pain. A trend toward a correlation with the kind of operation emerged anyway: total thyroidectomy was associated with the onset of post-operative neck pain, although failing to achieve a statistical significance (p = 0,052). Hopefully, future larger studies will clarify this aspect.
Our results resulted in line with the study of Lang et al (10): the Authors compare the post-operative pain in patients scheduled for thyroidectomy with or without neck hyperextension on the operative bed. The Authors reported that post-operative pain resulted associated with neck hyperextension: anyway, no correlation was made with the grade of inclination.
Unfortunately, our study fails to establish an ideal range of neck inclination to avoid postoperative neck pain; however, it could be recommended not to overextend the neck of patients undergoing open thyroidectomy. Indeed, overextension does not significantly improve the access to the thyroid gland, as reported by Serpell et al (4); on the other hand, it may promote the onset of postoperative pain and discomfort (10) which may persist for several days and may negatively affect daily life (2–6, 8–10).
The management of post-operative pain is a serious issue. It is of primary importance to implement a bundle of pain prevention that focuses on the early identification of patients at risk to be addressed to perform head-neck stretching exercises to increase the degree of elasticity of neck muscles (11). These exercises may lead to a decrease in the request for postoperative analgesics, limiting the unnecessary use of opioid drugs (12). Moreover, pain management improves post-operative comfort and patient satisfaction, it aids recovery and promotes rapid discharge.
Strategies reported in literature to treat post-operative neck pain include bilateral great occipital nerve blockade with bupivacaine (8), intraoperative transcutaneous electrical nerve stimulation applied on the trapezius muscle (13), and physiokinesiotherapy (9). Anyway, a further effort to assess factors associated with neck pain should be made in order to prevent it rather than treating it.