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 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.

Abstract

Systematic review of five studies (multimodal analgesia [MMA], n = 275; non‐MMA, n = 317). Studies found a significant decrease in overall postoperative narcotic usage (four studies), hospital length of stay (two studies) though subjective pain widely varied. There were no differences in surgical outcomes, medical complications, adverse effects, or 30‐day mortality and readmission rates.

Highlights

• Management of postoperative pain after head and neck cancer surgery is a complex issue, requiring a careful balance of analgesia and undesired side effects.

• Five studies ( n = 592 patients) reported on the use of nonsteroidal anti‐inflammatory drugs, acetaminophen, anticonvulsants, local anesthetics, and corticosteroids.

• Four studies described a significant decrease in overall postoperative narcotic usage though subjective pain scores widely varied.

• Multimodal analgesia is a popular and effective strategy that may reduce dependence on opioids for the treatment of postoperative pain.