Stellate Ganglion Blockade for Acute Pain Management After Transoral Robotic Surgery

Pharyngeal surgical site pain is a significant concern following transoral robotic surgery (TORS). The use of stellate ganglion blockade (SGB) has been reported as a treatment adjunct for postoperative pain.

Patients who underwent TORS and neck dissection for oropharyngeal carcinoma between November 2019 and May 2021 by a single surgeon (AHM) were included. Patients underwent either SGB via injection of bupivacaine or no SGB. Inpatient pain and total daily morphine milligram equivalent (MME) usage were calculated. A retrospective chart review was performed to identify time in the OR spent placing the SGB, length of hospitalization, and postoperative complications.

Seventy-three patients were included. Of these, 43 (58.9%) underwent SGB. On average, SGB placement of any kind added 13 min to OR time prior to surgical start time. Patients who underwent SGB had significantly lower average pain scores over the postoperative time course (mean difference 0.75, 95% CI: 0.09-1.41, p = 0.027) and lower opioid consumption over time (mean difference 16.37 MME, 95% CI: 6.98-25.77, p < 0.001) compared with those who did not undergo SGB.

SGB resulted in less narcotic pain medication use in the immediate postoperative period, without affecting length of hospitalization or rate of adverse events. SGB is a safe and effective adjunct to multimodal therapy for pain control in the postoperative period following TORS for laryngopharyngeal head and neck cancer.