Nonopioid perioperative analgesia in head and neck cancer surgery: A systematic review

Abstract

Objective Management of postoperative pain after head and neck cancer surgery is a complex issue, requiring a careful balance of analgesic properties and side effects. The objective of this review is to discuss the efficacy and safety of multimodal analgesia (MMA) for these patients. Methods Pubmed, Cochrane, Embase, Scopus, and http://clinicaltrials.gov were systematically searched for all comparative studies of patients receiving MMA (nonsteroidal anti‐inflammatory drugs (NSAIDs), acetaminophen, anticonvulsants, local anesthetics, and corticosteroids) for head and neck cancer surgeries. The primary outcome was additional postoperative opioid usage, and secondary outcomes included subjective pain scores, complications, adverse effects, and 30‐day outcomes. Results A total of five studies representing 592 patients (MMA, n = 275; non‐MMA, n = 317) met inclusion criteria. The most commonly used agents were gabapentin, NSAIDs, and acetaminophen (n = 221), NSAIDs (n = 221), followed by corticosteroids (n = 35), dextromethorphan (n = 40), and local nerve block (n = 19). Four studies described a significant decrease in overall postoperative narcotic usage with two studies reporting a significant decrease in hospital time. Subjective pain scores widely varied with two studies reporting reduced pain at postoperative day 3. There were no differences in surgical outcomes, medical complications, adverse effects, or 30‐day mortality and readmission rates. Conclusion MMA is an increasingly popular strategy that may reduce dependence on opioids for the treatment of postoperative pain. A variety of regimens and protocols are available for providers to utilize in the appropriate head and neck cancer patient.

Injectable fillers: current status, physicochemical properties, function mechanism, and perspectives

“…Compared with other biomaterials for the treatment of wrinkle lines and so tissue loss, which degrade within a few months to years, PMMA is a non-resorbable synthetic chemical with a permanent effect. 58 Artecoll is a permanent ller made up of 20% PMMA microspheres suspended in an 80% bovine collagen solution (3.5% bovine collagen, 2.7% phosphate buffer, 0.9% sodium chloride, 0.3% lidocaine hydrochloride and 92.6% water). 59 ArteFill is another version of Artecoll that was rebranded as Bellall in 2014.…”

Pain treatment and prophylaxis on pain

“…Opioids are strong painkillers in the acute setting and are appropriate to use on top of multimodal analgesia postoperatively when needed, but not as prophylaxis. [44,45]. However, the have a number of well known side-effects and especially hyperalgesia and the addiction potential are much in focus presently [2,19 ▪ ].…”