Postoperative pain scores with use and non-use of drain after thyroid surgery at CHUK and Kibungo referral hospital: a randomized controlled trial

Abstract

ABSTRACT Background: Prophylactic drainage after thyroid surgery is still common practice among surgeons despite no tangible scientific evidence to support its benefits. Current evidence suggests its usage to be harmful to the patients as they are linked to infections, hematoma and increased levels of pain. So far, there are no consensus in current Rwandan surgical practice. The main purpose of this study was to investigate the levels of pain in patients with drainage after thyroid surgery. Methodology: It was a prospective clinical trial done at CHUK and KRH from January to June 2020. In total, 34 patients were enrolled in two arms: the first group received a drain postoperatively while the second group did not receive any type of drainage. Results: the rate of haematoma and seroma formation was the same in the drain and the no-drain group (P=0.628). There was no case of wound dehiscence in both groups and only 1 case of wound infection in the no-drain group. The mean average pain score after 6 hours was: 5 (±2.02) in the drain group and 6 (±1.39) in the no-drain group. The mean average pain score after 24 hours was: 3 (± 1.8) in the drain group and 4 (± 1.67) in the no drain group. Most of the patients in the drain group had dysphagia (P=0.03) and more prone to dysphonia within the first six hours postoperatively. However, those signs and symptoms would disappear within 24 hours. Conclusions: the prophylactic drainage after thyroid surgery displayed no tangible benefits and there is evidence of discomfort among patients with a drain. However, due to the inherent limitations of our study, we could not link drainage to higher postoperative pain levels. Therefore, we recommend bigger and multi-center clinical trials to better investigate the impact of the drainage on postoperative pain and other complications related to thyroid surgery.