The following article features coverage from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) Annual Meeting. Click here to read more of MPR‘s conference coverage.

Multimodel anesthesia (MMA) may significantly decrease postoperative opioid use following head and neck cancer surgery, according to a systematic review presented at the AAO-HNS 2021 Annual Meeting, held October 3-6 in Los Angeles, California.

To analyze the safety and efficacy of using nonopioid analgesia for postop pain, study authors searched PubMed, Cochrane, Scopus, Embase, and ClinicalTrials.gov for studies comparing patients who received opioids vs MMA for major head and neck cancer surgeries. Therapeutic options for MMA included gabapentin, corticosteroids, local anesthetics, acetaminophen, and nonsteroidal anti-inflammatory drugs.


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The primary outcome was postoperative opioid usage; secondary outcomes included length of hospital stay, medical complications, subjective pain scores, adverse effects, and 30-day outcomes (mortality and readmission rates).

Ten studies (N=1253) were included in the review; 594 patients received MMA, while 659 received non-MMA therapy. Out of the therapeutic options available for MMA, gabapentin was the most commonly used (n=433), followed by nonsteroidal anti-inflammatory drugs (n=265), acetaminophen (n=263), and corticosteroids (n=149).

Overall, 8 studies showed a significant decrease in daily postoperative opioid usage at time of discharge. “Subjective pain had wider variation, with the majority of studies citing significant pain improvement,” the authors noted. No differences were observed in other secondary outcomes.

Based on their findings, study authors concluded that “MMA may play an important role in the treatment of postoperative pain after head and neck cancer surgery.” Due to study heterogeneity, a meta-analysis reporting on overall efficacy could not be completed.

Reference

Go BC, Chorath K, Go CC, Moreira AG, Rajasekaran K. Nonopioid perioperative analgesia for major head and neck cancer surgeries. Presented at: AAO-HNS 2021 Annual Meeting; October 3-6, 2021; Los Angeles, CA.