Trakimas Danielle R, Perez-Heydrich Carlos, Mandal Rajarsi, Tan Marietta, Gourin Christine G, Fakhry Carole, Koch Wayne M, Russell Jonathon O, Tufano Ralph P, Eisele David W, Vosler Peter S
Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, United States.
Front Psychiatry. 2022 Jul 8;13:857083. doi: 10.3389/fpsyt.2022.857083. eCollection 2022.
Pain management is an important consideration for Head and Neck Cancer (HNC) patients as they are at an increased risk of developing chronic opioid use, which can negatively impact both quality of life and survival outcomes. This retrospective cohort study aimed to evaluate pain, opioid use and opioid prescriptions following HNC surgery. Participants included patients undergoing resection of a head and neck tumor from 2019-2020 at a single academic center with a length of admission (LOA) of at least 24 h. Exclusion criteria were a history of chronic pain, substance-use disorder, inability to tolerate multimodal analgesia or a significant post-operative complication. Subjects were compared by primary surgical site: Neck (neck dissection, thyroidectomy or parotidectomy), Mucosal (resection of tumor of upper aerodigestive tract, excluding oropharynx), Oropharyngeal (OP) and Free flap (FF). Average daily pain and total daily opioid consumption (as morphine milligram equivalents, MME) and quantity of opioids prescribed at discharge were compared. A total of 216 patients met criteria. Pain severity and daily opioid consumption were comparable across groups on post-operative day 1, but both metrics were significantly greater in the OP group on the day prior to discharge (DpDC) (5.6 (1.9-8.6), < 0.05; 49 ± 44 MME/day, < 0.01). The quantity of opioids prescribed at discharge was associated with opioid consumption on the DpDC only in the Mucosal and FF groups, which had longer LOA (6-7 days) than the Neck and OP groups (1 day, < 0.001). Overall, 65% of patients required at least one dose of an opioid on the DpDC, yet 76% of patients received a prescription for an opioid medication at discharge. A longer LOA (aOR = 0.82, 95% CI: 0.63-0.98) and higher Charlson Comorbidity Index (aOR = 0.08, 95% CI: 0.01-0.48) were negatively associated with receiving an opioid prescription at the time of discharge despite no opioid use on the DpDC, respectively. HNC patients, particularly those with shorter LOA, may be prescribed opioids in excess of their post-operative needs, highlighting the need the for improved pain management algorithms in this patient population. Future work aims to use prospective surveys to better define post-operative and outpatient pain and opioid requirements following HNC surgery.
疼痛管理是头颈癌（HNC）患者的一项重要考量因素，因为他们患慢性阿片类药物使用障碍的风险增加，这会对生活质量和生存结果产生负面影响。这项回顾性队列研究旨在评估HNC手术后的疼痛、阿片类药物使用情况及阿片类药物处方。研究对象包括2019年至2020年在单一学术中心接受头颈肿瘤切除术且住院时长（LOA）至少为24小时的患者。排除标准为有慢性疼痛病史、物质使用障碍、无法耐受多模式镇痛或有严重术后并发症。根据主要手术部位对受试者进行比较：颈部（颈部清扫术、甲状腺切除术或腮腺切除术）、黏膜（上呼吸道消化道肿瘤切除术，不包括口咽）、口咽（OP）和游离皮瓣（FF）。比较了平均每日疼痛程度、每日阿片类药物总消耗量（以吗啡毫克当量，MME计）以及出院时开具的阿片类药物数量。共有216名患者符合标准。术后第1天，各组的疼痛严重程度和每日阿片类药物消耗量相当，但在出院前一天（DpDC），OP组的这两项指标均显著更高（5.6（1.9 - 8.6），< 0.05；49 ± 44 MME/天，< 0.01）。仅在黏膜组和FF组中，出院时开具的阿片类药物数量与DpDC时的阿片类药物消耗量相关，这两组的住院时长（6 - 7天）比颈部组和OP组（1天）更长（< 0.001）。总体而言，65%的患者在DpDC时需要至少一剂阿片类药物，但76%的患者在出院时收到了阿片类药物处方。住院时长较长（调整后比值比[aOR] = 0.82，95%置信区间[CI]：0.63 - 0.98）和较高的Charlson合并症指数（aOR = 0.08，95% CI：0.01 - 0.48）分别与出院时开具阿片类药物处方呈负相关，尽管在DpDC时未使用阿片类药物。HNC患者，尤其是住院时长较短的患者，可能会被开具超出其术后需求的阿片类药物，这凸显了在这一患者群体中改进疼痛管理算法的必要性。未来的工作旨在通过前瞻性调查更好地确定HNC手术后的术后及门诊疼痛情况和阿片类药物需求。
