A Multimodal Analgesia Protocol to Reduce Opioid Use Following Oral Cavity Free Flap Reconstruction

Area of Science:

• Oncology
• Pain Management
• Surgical Recovery

Background:

• Opioid-based patient-controlled analgesia (PCA) is standard for head and neck cancer surgery pain.
• PCA use is associated with risks like dependence, sedation, and respiratory depression.
• Multimodal analgesia (MMA) presents a potential alternative with fewer adverse effects.

Purpose of the Study:

• To compare the efficacy of MMA versus PCA for pain management after oral cavity resection with free flap reconstruction.
• To evaluate differences in opioid consumption and pain scores between the two analgesia strategies.

Main Methods:

• Retrospective analysis of 237 patients undergoing oral cavity resection and free flap reconstruction.
• Comparison of a multimodal analgesia (MMA) regimen (acetaminophen, celecoxib, gabapentin) against patient-controlled analgesia (PCA).
• Outcomes assessed included postoperative opioid use, pain scores, and complications.

Main Results:

• The MMA group (n=117) showed significantly lower opioid use on all postoperative days compared to the PCA group (n=120).
• Greatest opioid use reduction in the MMA group was observed on postoperative days 1 and 2.
• Pain scores were significantly lower in the MMA group across all postoperative days.

Conclusions:

• Multimodal analgesia (MMA) provides effective pain control following oncologic oral cavity resection with free flap reconstruction.
• MMA significantly reduces opioid requirements compared to PCA in this patient population.
• MMA represents a safer and effective strategy for managing postoperative pain after major head and neck cancer surgery.