Contrasting opioid use for pain management in microvascular head and neck reconstruction: an international study

A M Weyh; R Pucci; E Busby; L Kansal; R Joy; A Bunnell; V Valentini; D Dyalram; A Pattatheyill; M Figari; L Boccalatte; J Larrañaga; A Cassoni; R Fernandes

doi:10.1016/j.ijom.2022.04.016

Contrasting opioid use for pain management in microvascular head and neck reconstruction: an international study

Int J Oral Maxillofac Surg. 2022 Nov;51(11):1412-1419. doi: 10.1016/j.ijom.2022.04.016. Epub 2022 May 20.

Authors

A M Weyh¹, R Pucci², E Busby³, L Kansal⁴, R Joy⁵, A Bunnell⁶, V Valentini⁷, D Dyalram⁸, A Pattatheyill⁹, M Figari¹⁰, L Boccalatte¹¹, J Larrañaga¹², A Cassoni¹³, R Fernandes¹⁴

Affiliations

¹ Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA. Electronic address: [email protected].
² Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy. Electronic address: [email protected].
³ Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA. Electronic address: [email protected].
⁴ Department of Head and Neck Surgery, Tata Medical Center, Kolkata, India. Electronic address: [email protected].
⁵ Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA. Electronic address: [email protected].
⁶ Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA. Electronic address: [email protected].
⁷ Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy. Electronic address: [email protected].
⁸ Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA. Electronic address: [email protected].
⁹ Department of Head and Neck Surgery, Tata Medical Center, Kolkata, India. Electronic address: [email protected].
¹⁰ Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Electronic address: [email protected].
¹¹ Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Electronic address: [email protected].
¹² Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Electronic address: [email protected].
¹³ Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy. Electronic address: [email protected].
¹⁴ Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA. Electronic address: [email protected].

PMID: 35599083
DOI: 10.1016/j.ijom.2022.04.016

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.

Keywords: Analgesia; Free tissue flaps; Head and neck cancer; Microsurgery; Opioids; Pain management; Reconstructive surgical procedures.

Publication types

Multicenter Study

MeSH terms

Analgesics, Opioid / therapeutic use
Cohort Studies
Free Tissue Flaps* / blood supply
Head and Neck Neoplasms*
Humans
Pain Management / methods
Plastic Surgery Procedures* / methods
Retrospective Studies

Substances

Analgesics, Opioid