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

Ben B Levy¹, Julia Wiercigroch², Lomesh Choudhary³

¹Department of Otolaryngology-Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

|April 26, 2026

Abstract

Background:

Opioid-based patient-controlled analgesia (PCA) is widely used after head and neck cancer surgery but carries risks such as dependence, sedation, and respiratory depression. Multimodal analgesia (MMA) may offer acceptable pain control with fewer adverse effects.

Methods:

We retrospectively analyzed patients who underwent oral cavity resection with free flap reconstruction over 18 months. An MMA regimen of scheduled acetaminophen, celecoxib, and gabapentin was compared to PCA. Outcomes included opioid use, pain scores, and complications.

Results:

A total of 237 patients were included (PCA: n = 120; MMA: n = 117). The mean age was 64.3 years (SD = 13.2). Opioid use was significantly lower in the MMA group on all postoperative days (PODs), with the greatest mean differences on POD 1 (MD = 75.3) and POD 2 (MD = 31.9) (both p < 0.001). Pain scores were significantly lower in the MMA group on all PODs (p < 0.05).

Conclusions:

MMA can provide comparable pain control while significantly reducing opioid use following oncologic oral cavity resection with free flap reconstruction.

Keywords:

multimodal analgesia opioid reduction opioid‐sparing strategies oral cavity cancer quantitative analysis

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