Efficacy and safety of lower extremity nerve blocks for postoperative analgesia at free fibular flap donor sites

Zhang, Xia; Sun, C. P.; Bai, Xiaofeng; Zhang, Qian

doi:10.1002/hed.25470

Cited by 14 publications

(25 citation statements)

References 30 publications

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“…Nine of 10 studies 16-24 (n = 1151) used an 11-point numerical scale to assess pain, including the visual analog scale (VAS) (6 studies, 16,20-24 n = 774) and the Defense & Veterans Pain Rating Scale (DVPRS) (1 study, 17 n = 65) ( Table 4 ). There was wide variation in subjective pain outcomes among the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies 15–23 used morphine milligram equivalents (MMEs) to assess additional narcotic usage while Zhang et al 24 reported additional use of sufentanyl. Other significantly improved functional metrics included sedation score, antiemetic use at postoperative day (POD) 1, and time from bed to chair 16 , 24 . While hospital length of stay was reported by 4 studies, 17,19,21,24 only Smith et al 21 found a significantly decreased time for the MMA group (7.8 vs 10.6 days, P =.…”

Section: Resultsmentioning

confidence: 99%

“…After duplicate removal and screening by abstract and title, 66 full-text articles were assessed with 10 studies ( 2RCTs, 1 open-label trial, 7 matched cohort studies) meeting inclusion criteria (Table 1). [15][16][17][18][19][20][21][22][23][24] A total of 1253 patients were included with 594 patients in the MMA group and 659 in the non-MMA group. Using weighted averages, the overall population was 62.0 6 5.4 years old and 68.6% male (MMA, 61.0 6 6.0 years, 69.2% male; non-MMA, 62.9 6 4.6 years, 68.0% male) with no difference between the 2 groups.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…Eight of 10 studies [15][16][17][18][19]21,23,24 (n = 1025) observed a significant decrease in overall postoperative narcotic usage (Table 3). Nine studies [15][16][17][18][19][20][21][22][23] used morphine milligram equivalents (MMEs) to assess additional narcotic usage while Zhang et al 24 reported additional use of sufentanyl. Other significantly improved functional metrics included sedation score, antiemetic use at postoperative day (POD) 1, and time from bed to chair.…”

Section: Objective Measuresmentioning

confidence: 99%

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Multimodal Analgesia in Head and Neck Free Flap Reconstruction: A Systematic Review

Chorath

et al. 2021

Otolaryngol.--head neck surg.

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Objective Postoperative pain after head and neck cancer surgery is commonly treated with opioids, which are associated with considerable side effects. The objective of this study is to analyze the safety and efficacy of using multimodal analgesia (MMA) for patients undergoing head and neck cancer surgery with free flap reconstruction. Data Sources A systematic search was conducted in PubMed, Cochrane, Embase, Scopus, and clinicaltrials.gov. Review Methods All studies comparing patients receiving MMA (gabapentin, corticosteroids, local anesthetic, acetaminophen, nonsteroidal anti-inflammatory drugs [NSAIDs]) vs patients receiving opioids for head and neck cancer surgery with free flap reconstruction were screened. The primary outcome was postoperative opioid usage. Secondary outcomes included length of stay, subjective pain scores, surgical/medical complications, adverse effects, and 30-day outcomes. Results A total of 10 studies representing 1253 patients (MMA, n = 594; non-MMA, n = 659) met inclusion criteria. Gabapentinoids were the most commonly used intervention (72.9%) followed by NSAIDs (44.6%), acetaminophen (44.3%), corticosteroids (25.1%), ketamine (7.2%), and nerve block (3.4%). Eight studies reported a significant decrease in postoperative opioid usage in the MMA groups. Subjective pain had wider variation, with most studies citing significant pain improvement. There were no differences in surgical outcomes, medical complications, adverse effects, or 30-day mortality and readmission rates. Conclusion With the rise of the opioid epidemic, MMA may play an important role in the treatment of postoperative pain after head and neck cancer surgery. A growing body of literature demonstrates a variety of effective perioperative regimens.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Section: Objective Measuresmentioning

confidence: 99%

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Multimodal Analgesia in Head and Neck Free Flap Reconstruction: A Systematic Review

Chorath

et al. 2021

Otolaryngol.--head neck surg.

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“…It is considered the most severe form of chronic pain because those who suffer from neuropathic pain may experience depression, anxiety and other harmful emotions. Drugs, such as opioids, have been demonstrated to be insufficient and cause severe side effects in neuropathic pain 2,3 . In recent years, stem cell transplantation has been reported to be a potent alternative to traditional therapies for controlling neuropathic pain 4,5 …”

Section: Introductionmentioning

confidence: 99%

Stem cells from human exfoliated deciduous teeth relieve pain via downregulation of c‐Jun in a rat model of trigeminal neuralgia

Bai

Xiao

Yang

et al. 2021

J of Oral Rehabilitation

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Background Stem cells from human exfoliated deciduous teeth (SHED) have excellent immunomodulatory and neuroprotective abilities. It is possible that systemic SHED transplantation could ameliorate trigeminal neuralgia. The phosphorylation of c‐Jun contributes to the development of hyperalgesia and allodynia. Objective The present study aimed to evaluate whether systemic SHED transplantation could lead to analgesic effects by regulating peripheral c‐Jun in the trigeminal ganglia (TG) in a rat model of trigeminal neuralgia. Methods Chronic constriction injury of the infraorbital nerve (CCI‐ION) was performed to establish a rat pain model. SHED were obtained from discarded exfoliated deciduous teeth from children and transplanted by a single infusion through the tail vein. SHED were labelled with the PKH26 red fluorescent cell linker mini kit for tract distribution. The mechanical threshold was determined using von Frey filaments. The mRNA levels of c‐Jun in the ipsilateral TG were quantified. The phosphorylation of c‐Jun in the ipsilateral TG was assessed by immunohistochemistry and Western blotting. Results PKH26‐labelled SHED were distributed to both sides of TG, lung, liver and spleen. Systemic SHED transplantation significantly elevated the mechanical thresholds in CCI‐ION rats and blocked the upregulation of c‐Jun mRNA levels in the TG caused by nerve ligation. The activation of c‐Jun in the TG was blocked by SHED transplantation. Conclusions These findings demonstrate that systemic SHED administration reverts trigeminal neuralgia via downregulation of c‐Jun in the TG.

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The Use of Dissemination and Implementation to Improve Multimodal Analgesia in Head and Neck Surgery

et al. 2022

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Objectives: To optimize the delivery of multimodal analgesia to patients undergoing major head and neck oncologic surgeries.Methods: Pilot study included patients enrolled to receive either scheduled acetaminophen and as-needed opioids (control group) or scheduled acetaminophen, gabapentin, ketorolac, and as-needed opioids (experimental group). RCT, a hybrid type 1 effectiveness-implementation pragmatic trial, was designed to test the effectiveness of the intervention. Arm A received scheduled acetaminophen and as-needed opioids. Arm B received scheduled gabapentin, ketorolac, a regional nerve block at the free tissue donor site, scheduled acetaminophen and as-needed opioids.Results: Pilot: Thirty-one patients undergoing major head and neck surgery were enrolled. Mean MMEs administered in control group (n = 15) was 251.60 mg (SD = 224.57 mg); mean MMEs in Experimental group (n = 16) was 195.78 mg (SD = 131.08 mg), p = 0.401. LOS was 8.0 days in control versus 7.0 days in experimental group (p = 0.054).RCT: Interim analysis for safety and futility was planned during trial's design after 30 patients (n = 14 Arm A, and n = 16 Arm B). Mean MMEs administered were 135.1 mg in Arm A, (SD = 86.0 mg) versus mean MME of 51.3 mg in Arm B (SD = 43.3 mg, (p < 0.05)). Given clear superiority results, the trial was prematurely terminated. Functional pain scores, LOS, and complications were similar between the arms (p > 0.05). Variability of mean MME was compared before and after implementation of the management protocols: SD in RCT#1 was 181.46 mg versus 124.6 mg in RCT#2.Conclusion: Multimodal analgesia significantly reduced the need for opioids in patients undergoing major head and neck surgery.

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Efficacy and safety of lower extremity nerve blocks for postoperative analgesia at free fibular flap donor sites

Cited by 14 publications

References 30 publications

Multimodal Analgesia in Head and Neck Free Flap Reconstruction: A Systematic Review

Multimodal Analgesia in Head and Neck Free Flap Reconstruction: A Systematic Review

Stem cells from human exfoliated deciduous teeth relieve pain via downregulation of c‐Jun in a rat model of trigeminal neuralgia

The Use of Dissemination and Implementation to Improve Multimodal Analgesia in Head and Neck Surgery

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