Reduction in opioids need with multimodal analgesia during head and neck surgery

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Created On: 20/01/2023

The goal of this pilot study was to offer multimodal analgesia to individuals having significant head and neck oncologic procedures in the most effective way possible.

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Key take away

In people undergoing major head and neck surgery, multimodal analgesia substantially minimizes the requirements for opioids.

Background

The goal of this pilot study was to offer multimodal analgesia to individuals having significant head and neck oncologic procedures in the most effective way possible.

Method

Participants in the control group received scheduled Acetaminophen and as-required opioids while participants in the experimental group received scheduled Acetaminophen, Gabapentin, Ketorolac, and as-required painkillers. For determining the intervention's efficacy, a hybrid type 1 efficacy-implementation pragmatic trial (RCT) was created.

In the RCT, Arm A was given scheduled acetaminophen and as-required opioids. On the other hand, Arm B was given scheduled Gabapentin, Ketorolac, a regional nerve block at the free tissue donor site, as-required opioids, and scheduled acetaminophen.

Result

A total of 31 patients undergoing significant head and neck surgery were incorporated. Mean morphine milligram equivalents (MMEs) delivered in the experimental group (n = 16) was 195.78 mg (standard deviation [SD] = 131.08 mg), compared to 251.60 mg (SD = 224.57 mg) in the control group (n = 15). The length of stay in the experimental group was 7.0 days compared to 8.0 days in the control group.

An interim assessment for safety and futility (n = 14 in Arm A and n = 16 in Arm B) was planned during the trial's design. In comparison to the mean MME of 51.3 mg in Arm B (SD = 43.3 mg), the mean MME given in Arm A was 135.1 mg (SD = 86.0 mg). The trial was prematurely ended due to data showing a clear superiority. Complications, length of stay, and functional pain scores were comparable between the arms.

Before and after the introduction of the management procedures, the mean MME's variability was compared: the SD in RCT#1 was 181.46 mg, while the SD in RCT#2 was 124.6 mg.