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

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Title: Efficacy of Multimodal Analgesia for Postoperative Pain Management in Head and Neck Cancer Patients.
Authors: Hinther, Ashley, Nakoneshny, Steven C., Chandarana, Shamir P., Matthews, T. Wayne, Hart, Robert, Schrag, Christiaan, Matthews, Jennifer, McKenzie, C. David, Fick, Gordon H., Dort, Joseph C., Simon, Christian
Source: Cancers; Mar2021, Vol. 13 Issue 6, p1266, 1p
Subject Terms: THERAPEUTIC use of narcotics, HEAD tumors, PERIOPERATIVE care, ANALGESIA, ACQUISITION of data methodology, ANALGESICS, RETROSPECTIVE studies, PLASTIC surgery, CANCER patients, TREATMENT effectiveness, MEDICAL records, NECK tumors, POSTOPERATIVE pain, PAIN management, EVALUATION
Abstract: Simple Summary: Chronic opioid use is a serious global health problem and surgery is often the point of initial exposure for many chronic opioid users. Multimodal analgesia (MMA) is an approach designed to reduce or eliminate opioid use in surgical patients, but it has not been studied in patients having major head and neck surgery. This study explores the impact of an MMA protocol on opioid prescribing practices in patients having major head and neck surgery with flap reconstruction. The results of this study will provide evidence to inform and guide pain management practice in this important patient population. The results of this study could also be applied to other areas of otorhinolaryngology. MMA is an important tool in the effort to reduce chronic opioid use. 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. [ABSTRACT FROM AUTHOR]
Copyright of Cancers is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Efficacy of Multimodal Analgesia for Postoperative Pain Management in Head and Neck Cancer Patients.
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  Data: <searchLink fieldCode="AR" term="%22Hinther%2C+Ashley%22">Hinther, Ashley</searchLink><br /><searchLink fieldCode="AR" term="%22Nakoneshny%2C+Steven+C%2E%22">Nakoneshny, Steven C.</searchLink><br /><searchLink fieldCode="AR" term="%22Chandarana%2C+Shamir+P%2E%22">Chandarana, Shamir P.</searchLink><br /><searchLink fieldCode="AR" term="%22Matthews%2C+T%2E+Wayne%22">Matthews, T. Wayne</searchLink><br /><searchLink fieldCode="AR" term="%22Hart%2C+Robert%22">Hart, Robert</searchLink><br /><searchLink fieldCode="AR" term="%22Schrag%2C+Christiaan%22">Schrag, Christiaan</searchLink><br /><searchLink fieldCode="AR" term="%22Matthews%2C+Jennifer%22">Matthews, Jennifer</searchLink><br /><searchLink fieldCode="AR" term="%22McKenzie%2C+C%2E+David%22">McKenzie, C. David</searchLink><br /><searchLink fieldCode="AR" term="%22Fick%2C+Gordon+H%2E%22">Fick, Gordon H.</searchLink><br /><searchLink fieldCode="AR" term="%22Dort%2C+Joseph+C%2E%22">Dort, Joseph C.</searchLink><br /><searchLink fieldCode="AR" term="%22Simon%2C+Christian%22">Simon, Christian</searchLink>
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  Data: Cancers; Mar2021, Vol. 13 Issue 6, p1266, 1p
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  Data: <searchLink fieldCode="DE" term="%22THERAPEUTIC+use+of+narcotics%22">THERAPEUTIC use of narcotics</searchLink><br /><searchLink fieldCode="DE" term="%22HEAD+tumors%22">HEAD tumors</searchLink><br /><searchLink fieldCode="DE" term="%22PERIOPERATIVE+care%22">PERIOPERATIVE care</searchLink><br /><searchLink fieldCode="DE" term="%22ANALGESIA%22">ANALGESIA</searchLink><br /><searchLink fieldCode="DE" term="%22ACQUISITION+of+data+methodology%22">ACQUISITION of data methodology</searchLink><br /><searchLink fieldCode="DE" term="%22ANALGESICS%22">ANALGESICS</searchLink><br /><searchLink fieldCode="DE" term="%22RETROSPECTIVE+studies%22">RETROSPECTIVE studies</searchLink><br /><searchLink fieldCode="DE" term="%22PLASTIC+surgery%22">PLASTIC surgery</searchLink><br /><searchLink fieldCode="DE" term="%22CANCER+patients%22">CANCER patients</searchLink><br /><searchLink fieldCode="DE" term="%22TREATMENT+effectiveness%22">TREATMENT effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22MEDICAL+records%22">MEDICAL records</searchLink><br /><searchLink fieldCode="DE" term="%22NECK+tumors%22">NECK tumors</searchLink><br /><searchLink fieldCode="DE" term="%22POSTOPERATIVE+pain%22">POSTOPERATIVE pain</searchLink><br /><searchLink fieldCode="DE" term="%22PAIN+management%22">PAIN management</searchLink><br /><searchLink fieldCode="DE" term="%22EVALUATION%22">EVALUATION</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Simple Summary: Chronic opioid use is a serious global health problem and surgery is often the point of initial exposure for many chronic opioid users. Multimodal analgesia (MMA) is an approach designed to reduce or eliminate opioid use in surgical patients, but it has not been studied in patients having major head and neck surgery. This study explores the impact of an MMA protocol on opioid prescribing practices in patients having major head and neck surgery with flap reconstruction. The results of this study will provide evidence to inform and guide pain management practice in this important patient population. The results of this study could also be applied to other areas of otorhinolaryngology. MMA is an important tool in the effort to reduce chronic opioid use. 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. [ABSTRACT FROM AUTHOR]
– Name: Abstract
  Label:
  Group: Ab
  Data: <i>Copyright of Cancers is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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    Identifiers:
      – Type: doi
        Value: 10.3390/cancers13061266
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 1
        StartPage: 1266
    Subjects:
      – SubjectFull: THERAPEUTIC use of narcotics
        Type: general
      – SubjectFull: HEAD tumors
        Type: general
      – SubjectFull: PERIOPERATIVE care
        Type: general
      – SubjectFull: ANALGESIA
        Type: general
      – SubjectFull: ACQUISITION of data methodology
        Type: general
      – SubjectFull: ANALGESICS
        Type: general
      – SubjectFull: RETROSPECTIVE studies
        Type: general
      – SubjectFull: PLASTIC surgery
        Type: general
      – SubjectFull: CANCER patients
        Type: general
      – SubjectFull: TREATMENT effectiveness
        Type: general
      – SubjectFull: MEDICAL records
        Type: general
      – SubjectFull: NECK tumors
        Type: general
      – SubjectFull: POSTOPERATIVE pain
        Type: general
      – SubjectFull: PAIN management
        Type: general
      – SubjectFull: EVALUATION
        Type: general
    Titles:
      – TitleFull: Efficacy of Multimodal Analgesia for Postoperative Pain Management in Head and Neck Cancer Patients.
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            – D: 15
              M: 03
              Text: Mar2021
              Type: published
              Y: 2021
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