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Association Between Multimodal Analgesia Administration and Perioperative Opioid Requirements in Patients Undergoing Head and Neck Surgery With Free Flap Reconstruction.
JAMA Otolaryngol Head Neck Surg. 2020 Jun 18 [Online ahead of print]JO

Abstract

Importance

The opioid epidemic has reignited interest in opioid-sparing strategies in managing pain. However, few studies have focused on opioid use during perioperative care in patients undergoing head and neck surgery with free flap reconstruction.

Objectives

To examine the association between multimodal analgesia (MMA) administration and perioperative opioid requirements in patients undergoing head and neck surgery with free flap reconstruction and to investigate whether MMA alters the duration of stay in the postanesthesia care unit (PACU).

Design, Setting, and Participants

In this retrospective case-control study, data were collected between April 1, 2016, and December 31, 2017. The study was conducted at a single cancer center in the United States. Participants were 357 patients 18 years or older scheduled for head and neck surgery with free flap reconstruction.

Exposures

Patients in the treatment group received oral celecoxib, gabapentin, and/or tramadol hydrochloride before surgery. Control group patients did not receive any of these medications.

Main Outcomes and Measures

The amount of opioid administered in the operating room and in the PACU was converted to morphine equivalent daily dose (MEDD) for comparison between the 2 groups. The duration of stay in the PACU was based on the start time and end time of PACU care recorded by nurses in the PACU.

Results

In total, 149 patients (mean [SD] age, 60.3 [13.7] years; 104 [69.8%] men) were included in the treatment group, and 208 patients (mean [SD] age, 64.2 [13.6] years; 146 [70.2%] men) were included in the control group. The mean (SD) MEDD of opioid given during surgery was 51.7 (19.8) in the treatment group and 67.9 (24.7) in the control group, for a difference in the means (treatment vs control) of -16.17 (95% CI, -20.81 to -11.52). In the PACU, the mean (SD) MEDD of opioid given was 11.7 (13.3) in the treatment group and 14.9 (15.7) in the control group, for a difference in the means (treatment vs control) of -3.22 (95% CI, -6.40 to -0.03). The MMA treatment remained largely associated with reduced amount of opioid given during surgery, in the PACU, and both combined after controlling for other important factors.

Conclusions and Relevance

This case-control study found that the patients who received MMA before head and neck surgery with free flap reconstruction required less opioid medication. The treatment group also had shorter duration of stay in the PACU compared with the control group.

Authors+Show Affiliations

Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston.Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston.Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston.Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston.Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston.Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32556065

Citation

Vu, Catherine N., et al. "Association Between Multimodal Analgesia Administration and Perioperative Opioid Requirements in Patients Undergoing Head and Neck Surgery With Free Flap Reconstruction." JAMA Otolaryngology-- Head & Neck Surgery, 2020.
Vu CN, Lewis CM, Bailard NS, et al. Association Between Multimodal Analgesia Administration and Perioperative Opioid Requirements in Patients Undergoing Head and Neck Surgery With Free Flap Reconstruction. JAMA Otolaryngol Head Neck Surg. 2020.
Vu, C. N., Lewis, C. M., Bailard, N. S., Kapoor, R., Rubin, M. L., & Zheng, G. (2020). Association Between Multimodal Analgesia Administration and Perioperative Opioid Requirements in Patients Undergoing Head and Neck Surgery With Free Flap Reconstruction. JAMA Otolaryngology-- Head & Neck Surgery. https://doi.org/10.1001/jamaoto.2020.1170
Vu CN, et al. Association Between Multimodal Analgesia Administration and Perioperative Opioid Requirements in Patients Undergoing Head and Neck Surgery With Free Flap Reconstruction. JAMA Otolaryngol Head Neck Surg. 2020 Jun 18; PubMed PMID: 32556065.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association Between Multimodal Analgesia Administration and Perioperative Opioid Requirements in Patients Undergoing Head and Neck Surgery With Free Flap Reconstruction. AU - Vu,Catherine N, AU - Lewis,Carol M, AU - Bailard,Neil S, AU - Kapoor,Ravish, AU - Rubin,M Laura, AU - Zheng,Gang, Y1 - 2020/06/18/ PY - 2021/06/18/pmc-release PY - 2020/6/20/entrez PY - 2020/6/20/pubmed PY - 2020/6/20/medline JF - JAMA otolaryngology-- head & neck surgery JO - JAMA Otolaryngol Head Neck Surg N2 - Importance: The opioid epidemic has reignited interest in opioid-sparing strategies in managing pain. However, few studies have focused on opioid use during perioperative care in patients undergoing head and neck surgery with free flap reconstruction. Objectives: To examine the association between multimodal analgesia (MMA) administration and perioperative opioid requirements in patients undergoing head and neck surgery with free flap reconstruction and to investigate whether MMA alters the duration of stay in the postanesthesia care unit (PACU). Design, Setting, and Participants: In this retrospective case-control study, data were collected between April 1, 2016, and December 31, 2017. The study was conducted at a single cancer center in the United States. Participants were 357 patients 18 years or older scheduled for head and neck surgery with free flap reconstruction. Exposures: Patients in the treatment group received oral celecoxib, gabapentin, and/or tramadol hydrochloride before surgery. Control group patients did not receive any of these medications. Main Outcomes and Measures: The amount of opioid administered in the operating room and in the PACU was converted to morphine equivalent daily dose (MEDD) for comparison between the 2 groups. The duration of stay in the PACU was based on the start time and end time of PACU care recorded by nurses in the PACU. Results: In total, 149 patients (mean [SD] age, 60.3 [13.7] years; 104 [69.8%] men) were included in the treatment group, and 208 patients (mean [SD] age, 64.2 [13.6] years; 146 [70.2%] men) were included in the control group. The mean (SD) MEDD of opioid given during surgery was 51.7 (19.8) in the treatment group and 67.9 (24.7) in the control group, for a difference in the means (treatment vs control) of -16.17 (95% CI, -20.81 to -11.52). In the PACU, the mean (SD) MEDD of opioid given was 11.7 (13.3) in the treatment group and 14.9 (15.7) in the control group, for a difference in the means (treatment vs control) of -3.22 (95% CI, -6.40 to -0.03). The MMA treatment remained largely associated with reduced amount of opioid given during surgery, in the PACU, and both combined after controlling for other important factors. Conclusions and Relevance: This case-control study found that the patients who received MMA before head and neck surgery with free flap reconstruction required less opioid medication. The treatment group also had shorter duration of stay in the PACU compared with the control group. SN - 2168-619X UR - https://www.unboundmedicine.com/medline/citation/32556065/Association_Between_Multimodal_Analgesia_Administration_and_Perioperative_Opioid_Requirements_in_Patients_Undergoing_Head_and_Neck_Surgery_With_Free_Flap_Reconstruction L2 - https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/jamaoto.2020.1170 DB - PRIME DP - Unbound Medicine ER -
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