Multimodal Analgesia in Head and Neck Free Flap Reconstruction: A Systematic Review

Beatrice C. Go, Cammille C. Go, Kevin Chorath, Alvaro Moreira, Karthik Rajasekaran

Resultado de la investigación: Review articlerevisión exhaustiva

5 Citas (Scopus)


Objective: Postoperative pain after head and neck cancer surgery is commonly treated with opioids, which are associated with considerable side effects. The objective of this study is to analyze the safety and efficacy of using multimodal analgesia (MMA) for patients undergoing head and neck cancer surgery with free flap reconstruction. Data Sources: A systematic search was conducted in PubMed, Cochrane, Embase, Scopus, and Review Methods: All studies comparing patients receiving MMA (gabapentin, corticosteroids, local anesthetic, acetaminophen, nonsteroidal anti-inflammatory drugs [NSAIDs]) vs patients receiving opioids for head and neck cancer surgery with free flap reconstruction were screened. The primary outcome was postoperative opioid usage. Secondary outcomes included length of stay, subjective pain scores, surgical/medical complications, adverse effects, and 30-day outcomes. Results: A total of 10 studies representing 1253 patients (MMA, n = 594; non-MMA, n = 659) met inclusion criteria. Gabapentinoids were the most commonly used intervention (72.9%) followed by NSAIDs (44.6%), acetaminophen (44.3%), corticosteroids (25.1%), ketamine (7.2%), and nerve block (3.4%). Eight studies reported a significant decrease in postoperative opioid usage in the MMA groups. Subjective pain had wider variation, with most studies citing significant pain improvement. There were no differences in surgical outcomes, medical complications, adverse effects, or 30-day mortality and readmission rates. Conclusion: With the rise of the opioid epidemic, MMA may play an important role in the treatment of postoperative pain after head and neck cancer surgery. A growing body of literature demonstrates a variety of effective perioperative regimens.

Idioma originalEnglish (US)
Páginas (desde-hasta)820-831
Número de páginas12
PublicaciónOtolaryngology - Head and Neck Surgery (United States)
EstadoPublished - may 2022

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


Profundice en los temas de investigación de 'Multimodal Analgesia in Head and Neck Free Flap Reconstruction: A Systematic Review'. En conjunto forman una huella única.

Citar esto