A retrospective analysis of pain and opioid usage in head and neck free flap reconstruction
Abstract Objectives Investigate opioid usage and postoperative pain in patients undergoing head and neck free flap surgery. Methods A retrospective review of 100 consecutive patients undergoing head and neck free flap reconstruction at two academic centers was performed. Data captured included demog...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-06-01
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| Series: | World Journal of Otorhinolaryngology-Head and Neck Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/wjo2.87 |
| _version_ | 1827915448250793984 |
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| author | Parhom Towfighi Alison Hill Jason R. Crossley Amanda Walsh James A. Leonard Jonathan P. Giurintano Matthew L. Pierce Michael J. Reilly |
| author_facet | Parhom Towfighi Alison Hill Jason R. Crossley Amanda Walsh James A. Leonard Jonathan P. Giurintano Matthew L. Pierce Michael J. Reilly |
| author_sort | Parhom Towfighi |
| collection | DOAJ |
| description | Abstract Objectives Investigate opioid usage and postoperative pain in patients undergoing head and neck free flap surgery. Methods A retrospective review of 100 consecutive patients undergoing head and neck free flap reconstruction at two academic centers was performed. Data captured included demographics, postoperative inpatient pain, pain at postoperative visits, morphine equivalent doses (MEDs) administration, medication history, and comorbidities. Data were analyzed using regression models, χ2 tests, and student's t‐tests. Results Seventy‐three percent of patients were discharged with opioid medication, with over half (53.4%) continuing to take opioids at their second postoperative visit, and over one‐third (34.2%) continuing to take them around 4‐month postoperatively. One out of every five (20.3%) opioid‐naïve patients chronically took opioids postoperatively. There was a poor association between inpatient postoperative pain scores and daily MEDs administered (R2 = 0.13, 0.17, and 0.22 in postoperative Days 3, 5, and 7, respectively). Neither preoperative radiotherapy nor postoperative complications were associated with an increase in opioid usage. Conclusions For patients undergoing head and neck free flap operations, opioid medications are commonly used for postoperative analgesia. This practice may increase the chance an opioid‐naïve patient uses opioids chronically. We found a poor association between MEDs administered and patient‐reported pain scores, which suggests that standardized protocols aimed at optimizing analgesia while reducing opioid administration may be warranted. Level of Evidence: 3 (Retrospective cohort study). |
| first_indexed | 2024-03-13T02:59:44Z |
| format | Article |
| id | doaj.art-76092e3d8b5540edb6b16125dc623d15 |
| institution | Directory Open Access Journal |
| issn | 2095-8811 2589-1081 |
| language | English |
| last_indexed | 2024-03-13T02:59:44Z |
| publishDate | 2023-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | World Journal of Otorhinolaryngology-Head and Neck Surgery |
| spelling | doaj.art-76092e3d8b5540edb6b16125dc623d152023-06-27T14:52:59ZengWileyWorld Journal of Otorhinolaryngology-Head and Neck Surgery2095-88112589-10812023-06-019215315910.1002/wjo2.87A retrospective analysis of pain and opioid usage in head and neck free flap reconstructionParhom Towfighi0Alison Hill1Jason R. Crossley2Amanda Walsh3James A. Leonard4Jonathan P. Giurintano5Matthew L. Pierce6Michael J. Reilly7Georgetown University School of Medicine Washington District of Columbia USAGeorgetown University School of Medicine Washington District of Columbia USADepartment of Otolaryngology—Head and Neck Surgery Medstar Georgetown Washington District of Columbia USADepartment of Otolaryngology—Head and Neck Surgery Medstar Georgetown Washington District of Columbia USADepartment of Otolaryngology—Head and Neck Surgery Medstar Georgetown Washington District of Columbia USADepartment of Otolaryngology—Head and Neck Surgery Medstar Georgetown Washington District of Columbia USADepartment of Otolaryngology—Head and Neck Surgery Medstar Georgetown Washington District of Columbia USADepartment of Otolaryngology—Head and Neck Surgery Medstar Georgetown Washington District of Columbia USAAbstract Objectives Investigate opioid usage and postoperative pain in patients undergoing head and neck free flap surgery. Methods A retrospective review of 100 consecutive patients undergoing head and neck free flap reconstruction at two academic centers was performed. Data captured included demographics, postoperative inpatient pain, pain at postoperative visits, morphine equivalent doses (MEDs) administration, medication history, and comorbidities. Data were analyzed using regression models, χ2 tests, and student's t‐tests. Results Seventy‐three percent of patients were discharged with opioid medication, with over half (53.4%) continuing to take opioids at their second postoperative visit, and over one‐third (34.2%) continuing to take them around 4‐month postoperatively. One out of every five (20.3%) opioid‐naïve patients chronically took opioids postoperatively. There was a poor association between inpatient postoperative pain scores and daily MEDs administered (R2 = 0.13, 0.17, and 0.22 in postoperative Days 3, 5, and 7, respectively). Neither preoperative radiotherapy nor postoperative complications were associated with an increase in opioid usage. Conclusions For patients undergoing head and neck free flap operations, opioid medications are commonly used for postoperative analgesia. This practice may increase the chance an opioid‐naïve patient uses opioids chronically. We found a poor association between MEDs administered and patient‐reported pain scores, which suggests that standardized protocols aimed at optimizing analgesia while reducing opioid administration may be warranted. Level of Evidence: 3 (Retrospective cohort study).https://doi.org/10.1002/wjo2.87free flap reconstructionhead and neckmultimodal analgesiaopioidspostoperative pain |
| spellingShingle | Parhom Towfighi Alison Hill Jason R. Crossley Amanda Walsh James A. Leonard Jonathan P. Giurintano Matthew L. Pierce Michael J. Reilly A retrospective analysis of pain and opioid usage in head and neck free flap reconstruction World Journal of Otorhinolaryngology-Head and Neck Surgery free flap reconstruction head and neck multimodal analgesia opioids postoperative pain |
| title | A retrospective analysis of pain and opioid usage in head and neck free flap reconstruction |
| title_full | A retrospective analysis of pain and opioid usage in head and neck free flap reconstruction |
| title_fullStr | A retrospective analysis of pain and opioid usage in head and neck free flap reconstruction |
| title_full_unstemmed | A retrospective analysis of pain and opioid usage in head and neck free flap reconstruction |
| title_short | A retrospective analysis of pain and opioid usage in head and neck free flap reconstruction |
| title_sort | retrospective analysis of pain and opioid usage in head and neck free flap reconstruction |
| topic | free flap reconstruction head and neck multimodal analgesia opioids postoperative pain |
| url | https://doi.org/10.1002/wjo2.87 |
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