Contrasting opioid use for pain management in microvascular head and neck reconstruction: an international study |
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| Institution: | 1. Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA;2. Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy;3. Department of Head and Neck Surgery, Tata Medical Center, Kolkata, India;4. Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA;5. Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina;1. Boston Children’s Hospital, Boston, Massachusetts, USA;2. Harvard School of Dental Medicine, Boston, Massachusetts, USA;3. Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA;4. Division of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA;5. Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA;1. Department of Stomatology, Shaoxing People’s Hospital, Shaoxing, Zhejiang Province, PR China;2. Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, PR China;1. Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany;2. Department of Oral and Maxillofacial Surgery, Red Cross Hospital, Kassel, Germany;1. Department of Oral and Maxillofacial Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK;2. Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK;1. Harvard School of Dental Medicine, Boston, Massachusetts, USA;2. Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA, USA;3. Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, MA, USA |
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| Abstract: | Opioids are often the mainstay of postoperative pain management, despite strong evidence of their ill effects and potential for long-term addiction. The goal of this study was to quantify opioid use and contrast pain management strategies of multiple international institutions performing fibula free flap reconstruction. A retrospective multicenter cohort study was designed, including five international centers. For inclusion, the patients had to have undergone a primary fibula free flap reconstruction of the mandible. A total of 185 patients were included. The median opioid use across all centers at 72 hours was 133 oral morphine equivalents. The highest utilization was in the USA (P < 0.001), which was approximately six times that of Italy, four times that of Argentina, and twice that of India, despite all centers performing a similar procedure. Based on this study there are clear differences in prescribing practices and ideologies among surgeons from different countries. |
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| Keywords: | Head and neck cancer Opioids Pain management Free tissue flaps Analgesia Reconstructive surgical procedures Microsurgery |
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