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

Ashley Hinther, Steven C Nakoneshny, Shamir P Chandarana, T Wayne Matthews, Robert Hart, Christiaan Schrag, Jennifer Matthews, C David McKenzie, Gordon H Fick, Joseph C Dort, Ashley Hinther, Steven C Nakoneshny, Shamir P Chandarana, T Wayne Matthews, Robert Hart, Christiaan Schrag, Jennifer Matthews, C David McKenzie, Gordon H Fick, Joseph C Dort

Abstract

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.

Keywords: head and neck cancer; head and neck surgery; multimodal analgesia; perioperative pain control; postoperative pain.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flow diagram. CHERP (Calgary Head and Neck Enhanced Recovery Program), MMA (multimodal analgesia).
Figure 2
Figure 2
Opioids administered as a proportion of total analgesics. This figure shows opioids administered as a proportion of the total analgesics administered per POD (postoperative day).
Figure 3
Figure 3
Mean daily OME consumption. Mean daily OME (oral morphine equivalents) consumption over the first 14 postoperative days.
Figure 4
Figure 4
Proportion of pain scores >3 per POD. This figure shows the proportion of pain scores that are >3 per POD (postoperative day).

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