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Porcine As a Training Module for Head and Neck Microvascular Reconstruction
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Inpatient Opioid Use in Head and Neck Microvascular Free Flap Reconstruction.

Patricia Timothee1, Alessandra Bliss1, Daniel Blumenthal1

  • 1Department of Otolaryngology-Head & Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
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PubMed
Summary

Head and neck reconstruction with osseous free flaps did not increase inpatient pain medication needs compared to nonosseous flaps. A multimodal analgesia protocol significantly reduced opioid use, while COVID-19 restrictions had no significant impact.

Keywords:
free flaphead neck canceropioidpain

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Area of Science:

  • Head and Neck Surgery
  • Plastic Surgery
  • Pain Management

Background:

  • Head and neck defects often require complex reconstruction.
  • Osseous microvascular free flaps offer structural advantages but may influence postoperative pain.
  • Understanding pain management in these patients is crucial for optimizing recovery.

Purpose of the Study:

  • To compare inpatient pain requirements between osseous and nonosseous microvascular free flap reconstructions for head and neck defects.
  • To evaluate the impact of a multimodal analgesia (MMA) protocol on opioid administration.
  • To assess the effect of COVID-19 visitor restrictions on inpatient opioid use.

Main Methods:

  • Retrospective chart review of 318 patients undergoing head and neck free flap reconstruction.
  • Morphine-equivalent doses (MEDs) were calculated to quantify inpatient opioid administration.
  • Statistical analyses included 2-tailed t tests and chi-squared analyses.

Main Results:

  • No significant difference in total or daily inpatient MEDs was found between osseous and nonosseous free flap groups (P > 0.05).
  • Implementation of an MMA protocol led to a significant reduction in daily MEDs (25.9 to 11.24, P < 0.0001).
  • COVID-19 visitor restrictions did not significantly alter total or daily MEDs compared to unrestricted periods (P > 0.05).

Conclusions:

  • Osseous free flap reconstruction for head and neck defects is not associated with increased inpatient opioid requirements compared to nonosseous flaps.
  • Multimodal analgesia protocols are effective in reducing inpatient opioid consumption.
  • COVID-19 visitor restrictions did not significantly impact inpatient opioid administration in this cohort.