Efficacy of postoperative pain management in head and neck cancer patients

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

Abstract

Background: Our study quantifies the effectiveness of perioperative pain control in a cohort of patients undergoing major head and neck surgery with free flap reconstruction. Our long-term goal is to improve pain control and thereby increase mobility, decrease postoperative complications and decrease hospital stay.

Methods: A retrospective analysis was performed at a tertiary, academic head and neck surgical oncology program in Calgary, Alberta, Canada from January 1, 2015 - December 31, 2015. Pain scores were recorded prospectively. Primary outcomes were frequency of postoperative pain assessments and pain intensity using the numeric rating scale.

Results: The cohort included 41 patients. Analysis was limited to pain scores recorded from postoperative days 1-14. There was an average of 7.3 pain measurements per day (SD 4.6, range 1-24) with the most frequent monitoring on postoperative days 1-4. Median pain scores ranged from 0 to 4.5 with the highest median score on postoperative day 6. The daily maximum pain scores recorded ranged from 8 to 10 with scores of 10 recorded on postoperative days 1, 2, 3, 5, 7, 8, and 10. Patients most frequently had inadequate pain control on postoperative days 1, 2, 4, and 5 with the majority occurring on postoperative day 1.

Conclusions: Postoperative pain control could be improved at our centre. The frequency of pain assessments is also highly variable. Ongoing measurement, audit, and feedback of analgesic protocol effectiveness is an excellent first step in improving perioperative pain management in patients undergoing major head and neck cancer surgery with free flap reconstruction.

Keywords: ERAS; Enhanced recovery after surgery; Head and neck cancer, quality improvement; Postoperative pain control; Postoperative pain management.

Conflict of interest statement

Ethics approval and consent to participate

The authors used A pRoject Ethics Community Consensus Initiative (ARECCI) framework to assess for and mitigate ethical risks, including the ARECCI Ethics Screening Tool and the ARECCI Ethics Guidelines. The project was deemed a quality improvement initiative with a minimal risk (ARECCI score = 1).

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Total number of pain assessments performed per postoperative day
Fig. 2
Fig. 2
Proportion of patients receiving > 2 pain assessments per postoperative day
Fig. 3
Fig. 3
Maximum and median pain scores per postoperative day
Fig. 4
Fig. 4
Proportion of mean daily pain scores > 3

References

    1. Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d'Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999;91(1):8–15. doi: 10.1097/00000542-199907000-00006.
    1. Wells N, Paeroa C, McCaffery M. Chapter 17 improving the quality of care through pain assessment and management. In: Hughes RG, ed. Patient safety and quality: an evidence-based handbook for nurses: Rockville (MD): Agency for Healthcare Research and Quality (US); 2008.
    1. Barr J, Boulind C, Foster JD, et al. Impact of analgesic modality on stress response following laparoscopic colorectal surgery: a post-hoc analysis of a randomised controlled trial. Tech Coloproctol. 2015;19(4):231–239. doi: 10.1007/s10151-015-1270-0.
    1. Scott MJ, Baldini G, Fearon KC, et al. Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations. Acta Anaesthesiol Scand. 2015;59(10):1212–1231. doi: 10.1111/aas.12601.
    1. Yeung JK, Dautremont JF, Harrop AR, et al. Reduction of pulmonary complications and hospital length of stay with a clinical care pathway after head and neck reconstruction. Plast Reconstr Surg. 2014;133(6):1477–1484. doi: 10.1097/PRS.0000000000000217.
    1. Yeung JK, Harrop R, McCreary O, et al. Delayed mobilization after microsurgical reconstruction: an independent risk factor for pneumonia. Laryngoscope. 2013;123(12):2996–3000. doi: 10.1002/lary.24241.
    1. Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review. JAMA Surg. 2017;152(7):691–697. doi: 10.1001/jamasurg.2017.0898.
    1. Kuo P-Y, Williams JE. Pain control in head and neck Cancer. In: Agulnik M, editor. Head and neck Cancer: InTech. 2012. pp. 351–370.
    1. Anderson KO, Mendoza TR, Valero V, et al. Minority cancer patients and their providers: pain management attitudes and practice. Cancer. 2000;88(8):1929–1938. doi: 10.1002/(SICI)1097-0142(20000415)88:8<1929::AID-CNCR23>;2-2.
    1. Jensen MP, McFarland CA. Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain. 1993;55(2):195–203. doi: 10.1016/0304-3959(93)90148-I.
    1. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short Form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP) Arthritis Care Res (Hoboken) 2011;63(Suppl 11):S240–S252. doi: 10.1002/acr.20543.
    1. Jensen MP, Karoly P, O'Riordan EF, Bland F, Jr, Burns RS. The subjective experience of acute pain. An assessment of the utility of 10 indices. Clin J Pain. 1989;5(2):153–159. doi: 10.1097/00002508-198906000-00005.
    1. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798–804. doi: 10.1111/j.1365-2702.2005.01121.x.
    1. Grond S, Zech D, Lynch J, Diefenbach C, Schug SA, Lehmann KA. Validation of World Health Organization guidelines for pain relief in head and neck cancer. A prospective study. Ann Otol Rhinol Laryngol. 1993;102(5):342–348. doi: 10.1177/000348949310200504.
    1. Zech DF, Grond S, Lynch J, Hertel D, Lehmann KA. Validation of World Health Organization guidelines for cancer pain relief: a 10-year prospective study. Pain. 1995;63(1):65–76. doi: 10.1016/0304-3959(95)00017-M.
    1. Organization WH. Cancer pain relief. 1996. . Accessed May 2017.
    1. van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007;18(9):1437–1449. doi: 10.1093/annonc/mdm056.
    1. Orgill R, Krempl GA, Medina JE. Acute pain management following laryngectomy. Arch Otolaryngol Head Neck Surg. 2002;128(7):829–832. doi: 10.1001/archotol.128.7.829.
    1. Bianchini C, Malago M, Crema L, et al. Post-operative pain management in head and neck cancer patients: predictive factors and efficacy of therapy. Acta Otorhinolaryngol Ital. 2016;36(2):91–96.
    1. Bianchini C, Maldotti F, Crema L, Malago M, Ciorba A. Pain in head and neck cancer: prevalence and possible predictive factors. J BUON. 2014;19(3):592–597.
    1. Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate enhanced recovery after surgery pathways. Can J Anaesth. 2015;62(2):203–218. doi: 10.1007/s12630-014-0275-x.
    1. Oderda GM, Evans RS, Lloyd J, et al. Cost of opioid-related adverse drug events in surgical patients. J Pain Symptom Manag. 2003;25(3):276–283. doi: 10.1016/S0885-3924(02)00691-7.
    1. Binczak M, Navez M, Perrichon C, et al. Management of somatic pain induced by head-and-neck cancer treatment: definition and assessment. Guidelines of the French Oto-rhino-laryngology- head and neck surgery society (SFORL). Eur Ann Otorhinolaryngol Head Neck Dis. 2014;131(4):243–7.
    1. Khan SK, Malviya A, Muller SD, et al. Reduced short-term complications and mortality following enhanced recovery primary hip and knee arthroplasty: results from 6,000 consecutive procedures. Acta Orthop. 2014;85(1):26–31. doi: 10.3109/17453674.2013.874925.
    1. Kalogera E, Bakkum-Gamez JN, Jankowski CJ, et al. Enhanced recovery in gynecologic surgery. Obstet Gynecol. 2013;122(2 Pt 1):319–328. doi: 10.1097/AOG.0b013e31829aa780.
    1. Miller TE, Thacker JK, White WD, et al. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg. 2014;118(5):1052–1061. doi: 10.1213/ANE.0000000000000206.
    1. Majumdar S, Das A, Kundu R, Mukherjee D, Hazra B, Mitra T. Intravenous paracetamol infusion: superior pain management and earlier discharge from hospital in patients undergoing palliative head-neck cancer surgery. Perspect Clin Res. 2014;5(4):172–177. doi: 10.4103/2229-3485.140557.
    1. Espitalier F, Testelin S, Blanchard D, et al. Management of somatic pain induced by treatment of head and neck cancer: postoperative pain. Guidelines of the French Oto-rhino-laryngology--head and neck surgery society (SFORL) Eur Ann Otorhinolaryngol Head Neck Dis. 2014;131(4):249–252. doi: 10.1016/j.anorl.2014.05.002.

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