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. Method...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-06-01
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| Series: | World Journal of Otorhinolaryngology-Head and Neck Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/wjo2.62 |
| _version_ | 1797733442934276096 |
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| author | Beatrice C. Go Cammille C. Go Kevin Chorath Alvaro Moreira Karthik Rajasekaran |
| author_facet | Beatrice C. Go Cammille C. Go Kevin Chorath Alvaro Moreira Karthik Rajasekaran |
| author_sort | Beatrice C. Go |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T12:29:12Z |
| format | Article |
| id | doaj.art-ecc3c8e7b328422ebb2a4e7868b2e396 |
| institution | Directory Open Access Journal |
| issn | 2095-8811 2589-1081 |
| language | English |
| last_indexed | 2024-03-12T12:29:12Z |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | World Journal of Otorhinolaryngology-Head and Neck Surgery |
| spelling | doaj.art-ecc3c8e7b328422ebb2a4e7868b2e3962023-08-29T18:05:48ZengWileyWorld Journal of Otorhinolaryngology-Head and Neck Surgery2095-88112589-10812022-06-018210711710.1002/wjo2.62Nonopioid perioperative analgesia in head and neck cancer surgery: A systematic reviewBeatrice C. Go0Cammille C. Go1Kevin Chorath2Alvaro Moreira3Karthik Rajasekaran4Department of Otorhinolaryngology University of Pennsylvania Philadelphia Pennsylvania USAPerelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USADepartment of Otorhinolaryngology University of Pennsylvania Philadelphia Pennsylvania USADepartment of Pediatrics, Division of Neonatology University of Texas Health‐San Antonio San Antonio Texas USADepartment of Otorhinolaryngology University of Pennsylvania Philadelphia Pennsylvania USAAbstract 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.https://doi.org/10.1002/wjo2.62analgesiahead and neck neoplasmNSAIDopioidspain management |
| spellingShingle | Beatrice C. Go Cammille C. Go Kevin Chorath Alvaro Moreira Karthik Rajasekaran Nonopioid perioperative analgesia in head and neck cancer surgery: A systematic review World Journal of Otorhinolaryngology-Head and Neck Surgery analgesia head and neck neoplasm NSAID opioids pain management |
| title | Nonopioid perioperative analgesia in head and neck cancer surgery: A systematic review |
| title_full | Nonopioid perioperative analgesia in head and neck cancer surgery: A systematic review |
| title_fullStr | Nonopioid perioperative analgesia in head and neck cancer surgery: A systematic review |
| title_full_unstemmed | Nonopioid perioperative analgesia in head and neck cancer surgery: A systematic review |
| title_short | Nonopioid perioperative analgesia in head and neck cancer surgery: A systematic review |
| title_sort | nonopioid perioperative analgesia in head and neck cancer surgery a systematic review |
| topic | analgesia head and neck neoplasm NSAID opioids pain management |
| url | https://doi.org/10.1002/wjo2.62 |
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