Multimodal Analgesia in Head and Neck Free Flap Reconstruction : A Systematic Review
OBJECTIVE: Postoperative pain after head and neck cancer surgery is commonly treated with opioids, which are associated with considerable side effects. The objective of this study is to analyze the safety and efficacy of using multimodal analgesia (MMA) for patients undergoing head and neck cancer surgery with free flap reconstruction.
DATA SOURCES: A systematic search was conducted in PubMed, Cochrane, Embase, Scopus, and clinicaltrials.gov.
REVIEW METHODS: All studies comparing patients receiving MMA (gabapentin, corticosteroids, local anesthetic, acetaminophen, nonsteroidal anti-inflammatory drugs [NSAIDs]) vs patients receiving opioids for head and neck cancer surgery with free flap reconstruction were screened. The primary outcome was postoperative opioid usage. Secondary outcomes included length of stay, subjective pain scores, surgical/medical complications, adverse effects, and 30-day outcomes.
RESULTS: A total of 10 studies representing 1253 patients (MMA, n = 594; non-MMA, n = 659) met inclusion criteria. Gabapentinoids were the most commonly used intervention (72.9%) followed by NSAIDs (44.6%), acetaminophen (44.3%), corticosteroids (25.1%), ketamine (7.2%), and nerve block (3.4%). Eight studies reported a significant decrease in postoperative opioid usage in the MMA groups. Subjective pain had wider variation, with most studies citing significant pain improvement. There were no differences in surgical outcomes, medical complications, adverse effects, or 30-day mortality and readmission rates.
CONCLUSION: With the rise of the opioid epidemic, MMA may play an important role in the treatment of postoperative pain after head and neck cancer surgery. A growing body of literature demonstrates a variety of effective perioperative regimens.
| Errataetall: |
CommentIn: J Oral Maxillofac Anesth. 2022 Jun;1:. - PMID 35859689 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:166 |
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| Enthalten in: |
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery - 166(2022), 5 vom: 03. Mai, Seite 820-831 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Go, Beatrice C [VerfasserIn] |
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| Links: |
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| Themen: |
362O9ITL9D |
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| Anmerkungen: |
Date Completed 04.05.2022 Date Revised 21.07.2022 published: Print-Electronic CommentIn: J Oral Maxillofac Anesth. 2022 Jun;1:. - PMID 35859689 Citation Status MEDLINE |
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| doi: |
10.1177/01945998211032910 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM329168339 |
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| 500 | |a CommentIn: J Oral Maxillofac Anesth. 2022 Jun;1:. - PMID 35859689 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVE: Postoperative pain after head and neck cancer surgery is commonly treated with opioids, which are associated with considerable side effects. The objective of this study is to analyze the safety and efficacy of using multimodal analgesia (MMA) for patients undergoing head and neck cancer surgery with free flap reconstruction | ||
| 520 | |a DATA SOURCES: A systematic search was conducted in PubMed, Cochrane, Embase, Scopus, and clinicaltrials.gov | ||
| 520 | |a REVIEW METHODS: All studies comparing patients receiving MMA (gabapentin, corticosteroids, local anesthetic, acetaminophen, nonsteroidal anti-inflammatory drugs [NSAIDs]) vs patients receiving opioids for head and neck cancer surgery with free flap reconstruction were screened. The primary outcome was postoperative opioid usage. Secondary outcomes included length of stay, subjective pain scores, surgical/medical complications, adverse effects, and 30-day outcomes | ||
| 520 | |a RESULTS: A total of 10 studies representing 1253 patients (MMA, n = 594; non-MMA, n = 659) met inclusion criteria. Gabapentinoids were the most commonly used intervention (72.9%) followed by NSAIDs (44.6%), acetaminophen (44.3%), corticosteroids (25.1%), ketamine (7.2%), and nerve block (3.4%). Eight studies reported a significant decrease in postoperative opioid usage in the MMA groups. Subjective pain had wider variation, with most studies citing significant pain improvement. There were no differences in surgical outcomes, medical complications, adverse effects, or 30-day mortality and readmission rates | ||
| 520 | |a CONCLUSION: With the rise of the opioid epidemic, MMA may play an important role in the treatment of postoperative pain after head and neck cancer surgery. A growing body of literature demonstrates a variety of effective perioperative regimens | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Rajasekaran, Karthik |e verfasserin |4 aut | |
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