Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-23T23:39:16.107Z Has data issue: false hasContentIssue false
  • English
  • Français

Non-opioid analgesics and post-operative pain following transoral robotic surgery for oropharyngeal cancer

Published online by Cambridge University Press:  10 January 2022

K M Van Abel ,
A B Sauer Open the ORCID record for A B Sauer [Opens in a new window] ,
S C Kruthiventi ,
T N Weingarten ,
D B Noel ,
D L Price ,
J L Kasperbauer ,
J R Janus ,
K D Olsen  and
E J Moore
K M Van Abel*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Rochester, Minnesota, USA
A B Sauer
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Rochester, Minnesota, USA
S C Kruthiventi
Affiliation:
Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
T N Weingarten
Affiliation:
Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
D B Noel
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Rochester, Minnesota, USA
D L Price
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Rochester, Minnesota, USA
J L Kasperbauer
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Rochester, Minnesota, USA
J R Janus
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Rochester, Minnesota, USA
K D Olsen
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Rochester, Minnesota, USA
E J Moore
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Rochester, Minnesota, USA
*
Author for correspondence: Dr Kathryn M Van Abel, Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic School of Medicine, 200 First St SW, Rochester, Minnesota55905, USA E-mail: [email protected] Fax: +1 507 284 8855
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To investigate associations between multimodal analgesia and post-operative pain among patients undergoing transoral robotic surgery for oropharyngeal squamous cell carcinoma.

Methods

Records of patients who underwent surgery from 5 September 2012 to 30 November 2016 were abstracted. Associations were assessed using multivariable analysis.

Results

A total of 216 patients (mean age of 59.1 years, 89.4 per cent male) underwent transoral robotic surgery (92.6 per cent were human papilloma virus positive, 87.5 per cent had stage T1–T2 tumours, and 82.9 per cent had stage N0–N1 nodes). Gabapentin (n = 86) was not associated with a reduction in severe pain. Ibuprofen (n = 72) was administered less often in patients with severe pain. Gabapentin was not associated with increased post-operative sedation (p = 0.624) and ibuprofen was not associated with increased bleeding (p = 0.221). Post-operative opioid usage was not associated with surgical duration, pharyngotomy, bilateral neck dissections, tumour stage, tumour size, subsite or gabapentin.

Conclusion

Scheduled low-dose gabapentin was not associated with improved pain control or increased respiratory depression. Ibuprofen was not associated with an increased risk of bleeding and may be under-utilised.

Keywords

AnalgesicsNon-NarcoticRobotic Surgical ProceduresOropharyngeal Neoplasms
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 6 , June 2022 , pp. 527 - 534
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr K Van Abel takes responsibility for the integrity of the content of the paper

References

Achim, V, Bolognone, RK, Palmer, AD, Graville, DJ, Light, TJ, Li, R et al. Long-term functional and quality-of-life outcomes after transoral robotic surgery in patients with oropharyngeal cancer. JAMA Otolaryngol Head Neck Surg 2018;144:18–27Google ScholarPubMed
Corry, J, Poon, W, McPhee, N, Milner, AD, Cruickshank, D, Porceddu, SV et al. Prospective study of percutaneous endoscopic gastrostomy tubes versus nasogastric tubes for enteral feeding in patients with head and neck cancer undergoing (chemo)radiation. Head Neck 2009;31:867–76CrossRefGoogle ScholarPubMed
Albergotti, WG, Jordan, J, Anthony, K, Abberbock, S, Wasserman-Wincko, T, Kim, S et al. A prospective evaluation of short-term dysphagia after transoral robotic surgery for squamous cell carcinoma of the oropharynx. Cancer 2017;123:3132–40CrossRefGoogle ScholarPubMed
Trasolini, NA, McKnight, BM, Dorr, LD. The opioid crisis and the orthopedic surgeon. J Arthroplasty 2018;33:3379–82.e1CrossRefGoogle ScholarPubMed
Chen, LH, Hedegaard, H, Warner, M. Drug-poisoning deaths involving opioid analgesics: United States, 1999–2011. NCHS Data Brief 2014;(166):1–8Google Scholar
Gomes, T, Greaves, S, van den Brink, W, Antoniou, T, Mamdani, MM, Paterson, JM et al. Pregabalin and the risk for opioid-related death: a nested case-control study. Ann Intern Med 2018;169:732–4CrossRefGoogle ScholarPubMed
Bialer, M. Chemical properties of antiepileptic drugs (AEDs). Adv Drug Deliv Rev 2012;64:887–95CrossRefGoogle Scholar
Doleman, B, Heinink, TP, Read, DJ, Faleiro, RJ, Lund, JN, Williams, JP. A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain. Anaesthesia 2015;70:1186–204CrossRefGoogle ScholarPubMed
Gomes, T, Juurlink, DN, Antoniou, T, Mamdani, MM, Paterson, JM, van den Brink, W. Gabapentin, opioids, and the risk of opioid-related death: a population-based nested case-control study. PLoS Med 2017;14:e1002396CrossRefGoogle ScholarPubMed
Mishriky, BM, Waldron, NH, Habib, AS. Impact of pregabalin on acute and persistent postoperative pain: a systematic review and meta-analysis. Br J Anaesth 2015;114:10–31CrossRefGoogle ScholarPubMed
Starmer, HM, Yang, W, Raval, R, Gourin, CG, Richardson, M, Kumar, R et al. Effect of gabapentin on swallowing during and after chemoradiation for oropharyngeal squamous cell cancer. Dysphagia 2014;29:396–402CrossRefGoogle ScholarPubMed
Pollei, TR, Hinni, ML, Moore, EJ, Hayden, RE, Olsen, KD, Casler, JD et al. Analysis of postoperative bleeding and risk factors in transoral surgery of the oropharynx. JAMA Otolaryngol Head Neck Surg 2013;139:1212–1810.1001/jamaoto.2013.5097CrossRefGoogle ScholarPubMed
Bedwell, JR, Pierce, M, Levy, M, Shah, RK. Ibuprofen with acetaminophen for postoperative pain control following tonsillectomy does not increase emergency department utilization. Otolaryngol Head Neck Surg 2014;151:963–6CrossRefGoogle Scholar
Fonseca, ACG, Engelhardt, MI, Huang, ZJ, Jiang, ZY, Yuksel, S, Roy, S. Effect of changing postoperative pain management on bleeding rates in tonsillectomy patients. Am J Otolaryngol 2018;39:445–7CrossRefGoogle ScholarPubMed
Mudd, PA, Thottathil, P, Giordano, T, Wetmore, RF, Elden, L, Jawad, AF et al. Association between ibuprofen use and severity of surgically managed posttonsillectomy hemorrhage. JAMA Otolaryngol Head Neck Surg 2017;143:712–17CrossRefGoogle ScholarPubMed
Pfaff, JA, Hsu, K, Chennupati, SK. The use of ibuprofen in posttonsillectomy analgesia and its effect on posttonsillectomy hemorrhage rate. Otolaryngol Head Neck Surg 2016;155:508–13CrossRefGoogle ScholarPubMed
Moore, EJ, Olsen, KD, Kasperbauer, JL. Transoral robotic surgery for oropharyngeal squamous cell carcinoma: a prospective study of feasibility and functional outcomes. Laryngoscope 2009;119:2156–64CrossRefGoogle ScholarPubMed
Moore, EJ, Olsen, KD, Martin, EJ. Concurrent neck dissection and transoral robotic surgery. Laryngoscope 2011;121:541–4CrossRefGoogle ScholarPubMed
Sessler, CN, Gosnell, MS, Grap, MJ, Brophy, GM, O'Neal, PV, Keane, KA et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002;166:1338–44CrossRefGoogle ScholarPubMed
Herasevich, V, Kor, DJ, Li, M, Pickering, BW. ICU data mart: a non-iT approach. A team of clinicians, researchers and informatics personnel at the Mayo Clinic have taken a homegrown approach to building an ICU data mart. Healthc Inform 2011;28:42, 44–5Google Scholar
Piccirillo, JF, Tierney, RM, Costas, I, Grove, L, Spitznagel, EL Jr. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004;291:2441–7CrossRefGoogle Scholar
Agency for Health Care Policy and Research, Rockville, Maryland. Management of cancer pain: guideline overview. J Natl Med Assoc 1994;86:571–3, 634Google Scholar
Lydiatt, WM, Patel, SG, O'Sullivan, B, Brandwein, MS, Ridge, JA, Migliacci, JC et al. Head and neck cancers--major changes in the American Joint Committee on cancer eighth edition cancer staging manual. CA Cancer J Clin 2017;67:122–37CrossRefGoogle ScholarPubMed
Cavalcante, AN, Sprung, J, Schroeder, DR, Weingarten, TN. Multimodal analgesic therapy with gabapentin and its association with postoperative respiratory depression. Anesth Analg 2017;125:141–6CrossRefGoogle ScholarPubMed
Weingarten, TN, Hawkins, NM, Beam, WB, Brandt, HA, Koepp, DJ, Kellogg, TA et al. Factors associated with prolonged anesthesia recovery following laparoscopic bariatric surgery: a retrospective analysis. Obes Surg 2015;25:1024–3010.1007/s11695-014-1468-7CrossRefGoogle ScholarPubMed
Attia, TM. Effect of paracetamol/prednisolone versus paracetamol/ibuprofen on post-operative recovery after adult tonsillectomy. Am J Otolaryngol 2018;39:476–80CrossRefGoogle ScholarPubMed
Ng, TT, Diamantaras, D, Priestley, J, Redman, J, De Silva, N, Mahanta, V. Is celecoxib a useful adjunct in the treatment of post-tonsillectomy pain in the adult population? A randomised, double-blind, placebo-controlled study. J Laryngol Otol 2017;131:S18–28CrossRefGoogle ScholarPubMed
Macintyre, PE, Jarvis, DA. Age is the best predictor of postoperative morphine requirements. Pain 1996;64:357–64CrossRefGoogle ScholarPubMed
Ready, LB. Acute pain: lessons learned from 25,000 patients. Reg Anesth Pain Med 1999;24:499–505Google ScholarPubMed