Efficacy of postoperative pain management in head and neck cancer patients

Hinther, Ashley; Nakoneshny, Steven C.; Chandarana, Shamir; Matthews, T. Wayne; Dort, Joseph C.

doi:10.1186/s40463-018-0274-y

Cited by 28 publications

(34 citation statements)

References 25 publications

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“…We used the optimal measurement scale for pain in this context since the VNS is reproducible, easy to use, and may be adopted by the patients themselves from the very first postoperative hours. A previous retrospective study quantified the effectiveness of pain management in head and neck cancer patients [10] and showed high postoperative pain scores up to day 5, but the type of surgery and the pain category were not specifically defined. Nevertheless, the conclusions of that study are in accordance with our findings.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative Pain Profile After Major Cervicofacial Cancer Surgery

et al. 2021

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Background: Despite its anticipation, postoperative pain may be still poorly managed in some cases, such as in patients undergoing major cervicofacial cancer surgery. Indeed, the postoperative pain associated with these surgeries is complex and multifactorial. Objective: To assess the profile of postoperative pain scores and opioid requirements in a cohort of consecutive patients undergoing major cancer cervicofacial surgery with or without reconstruction. Methods: A cohort of 42 consecutive patients was studied. The following parameters were recorded: patients characteristics, type of surgery, preoperative medication preoperative pain scores, and postoperative pain score (5-point numerical verbal scale) upon arrival at the postanesthesia care unit (PACU) and at Day 1 to Day 7 (11-point visual numeric scale), the presence or absence of neuropathic and/or chronic pain one year later (determined by a phone interview), and morphine consumption. Results: All patients had a pain score of less than 3 in the PACU. From postoperative day 1 to day 7, pain scores were extremely variable and stayed high or even increased up to 7 in many patients. At the one-year phone interview, some patients had neuropathic and chronic pain.Discussion: Postoperative pain profiles in major cervicofacial cancer are complex, with high interindividual variability and with cases with neuropathic patterns and high pain scores that can last up to 7 days postoperatively.

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Section: Discussionmentioning

confidence: 99%

“…Signs of central sensitization (allodynia and hyperalgesia) are also reported. In this context, the onset of pain may be delayed compared to the surgery date [10].…”

Section: Introductionmentioning

confidence: 99%

Postoperative Pain Profile After Major Cervicofacial Cancer Surgery

et al. 2021

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“…Two patient groups were compared. A pre-MMA cohort that included patients who underwent surgery between January 2015–December 2015 and were managed using the Calgary Head and Neck Enhanced Recovery Program (CHERP) protocol [ 4 , 17 , 18 ]. The MMA cohort included all patients who underwent surgery between December 2017–June 2019 and received the CHERP protocol plus additional ERAS elements including treatment with MMA.…”

Section: Methodsmentioning

confidence: 99%

“…Head and neck cancer patients undergoing surgical resection with free-flap reconstruction represent a unique population; patients experience pain secondary to surgery as well as postoperative interventions including nasogastric and tracheotomy tubes [ 3 ]. Pain management following major head and neck surgery therefore represents a complex challenge, wherein opioids have traditionally been a mainstay in management [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Historically, our centre treated pain after major head and neck cancer surgery with opioids. However, despite the preponderant use of opioids, our patients’ pain was not optimally managed [ 4 ]. Given these results, we believe multimodal analgesia (MMA) may be an effective method of postoperative pain management in head and neck cancer surgery.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Multimodal Analgesia for Postoperative Pain Management in Head and Neck Cancer Patients

Hinther

Nakoneshny

Chandarana

et al. 2021

Cancers

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Postoperative opioid use has been linked to the subsequent development of opioid dependency. Multimodal analgesia (MMA) can reduce the use of opioids in the postoperative period, but MMA has not been well-studied after major head and neck surgery. Our goal is to explore the association between MMA and postoperative opioid use and pain control in patients undergoing major head and neck surgery. We performed a retrospective study in adult (age 18 years) patients undergoing primary head and neck cancer resection with free-flap reconstruction. All patients were treated using an established care pathway. The baseline group was treated between January 2015–December 2015 (n = 41), prior to the implementation of MMA, and were compared to an MMA-treated cohort treated between December 2017–June 2019 (n = 97). The primary outcome was the proportion of opioids prescribed and oral morphine equivalents (OMEs) consumed during the hospitalization. The secondary outcome was pain control. We found that the post-MMA group consumed fewer opioids in the postoperative period compared to the pre-MMA group. Prior to post-operative day (POD) 6, pain control was better in the post-MMA group; however, the pain control lines intersect on POD 6 and the pre-MMA group appeared to have better pain control from PODs 7–10. In conclusion, our data suggest MMA is an effective method of pain control and opioid reduction in patients undergoing surgery for head and neck cancer with free flap reconstruction. MMA use was associated with a significant decrease in the quantity of opioids consumed postoperatively. The MMA protocol was associated with improved pain management early in the postoperative course. Finally, the MMA protocol is a feasible method of pain control and may reduce the adverse side effects associated with opioid use.

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Association of Perioperative Opioid-Sparing Multimodal Analgesia With Narcotic Use and Pain Control After Head and Neck Free Flap Reconstruction

Eggerstedt

Stenson

Ramirez

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCEAn increase in narcotic prescription patterns has contributed to the current opioid epidemic in the United States. Opioid-sparing perioperative analgesia represents a means of mitigating the risk of opioid dependence while providing superior perioperative analgesia.OBJECTIVE To assess whether multimodal analgesia (MMA) is associated with reduced narcotic use and improved pain control compared with traditional narcotic-based analgesics at discharge and in the immediate postoperative period after free flap reconstructive surgery. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study assessed a consecutive sample of 65 patients (28 MMA, 37 controls) undergoing free flap reconstruction of a through-and-through mucosal defect within the head and neck region at a tertiary academic referral center from June 1, 2017, to November 30, 2018. Patients and physicians were not blinded to the patients' analgesic regimen. Patients' clinical courses were followed up for 30 days postoperatively.INTERVENTIONS Patients were administered a preoperative, intraoperative, and postoperative analgesia regimen consisting of scheduled and as-needed neuromodulating and anti-inflammatory medications, with narcotic medications reserved for refractory cases. Control patients were administered traditional narcotic-based analgesics as needed.MAIN OUTCOMES AND MEASURES Narcotic doses administered during the perioperative period and at discharge were converted to morphine-equivalent doses (MEDs) for comparison. Postoperative Defense and Veterans Pain Rating Scale pain scores (ranging from 0 [no pain] to 10 [worst pain imaginable]) were collected for the first 72 hours postoperatively as a patient-reported means of analyzing effectiveness of analgesia.RESULTS A total of 28 patients (mean [SD] age, 64.1 [12.3] years; 17 [61%] male) were included in the MMA group and 37 (mean [SD] age, 65.0 [11.0] years; 22 [59%] male) in the control group. The number of MEDs administered postoperatively was 10.0 (interquartile range [IQR], 2.7-23.1) in the MMA cohort and 89.6 (IQR, 60.0-104.5) in the control cohort (P < .001). Mean (SD) Defense and Veterans Pain Rating Scale pain scores postoperatively were 2.05 (1.41) in the MMA cohort and 3.66 (1.99) in the control cohort (P = .001). Median number of MEDs prescribed at discharge were 0 (IQR, 0-18.8) in the MMA cohort and 300.0 (IQR, 262.5-412.5) in the control cohort (P < .001). CONCLUSIONS AND RELEVANCEThe findings suggest that after free flap reconstruction, MMA is associated with reduced narcotic use at discharge and in the immediate postoperative period and with superior analgesia as measured by patient-reported pain scores. Patients receiving MMA achieved improved pain control, and the number of narcotic prescriptions in circulation were reduced.LEVEL OF EVIDENCE 3.

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Efficacy of postoperative pain management in head and neck cancer patients

Cited by 28 publications

References 25 publications

Postoperative Pain Profile After Major Cervicofacial Cancer Surgery

Postoperative Pain Profile After Major Cervicofacial Cancer Surgery

Efficacy of Multimodal Analgesia for Postoperative Pain Management in Head and Neck Cancer Patients

Association of Perioperative Opioid-Sparing Multimodal Analgesia With Narcotic Use and Pain Control After Head and Neck Free Flap Reconstruction

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