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Cranio-maxillofacial reconstruction with microvascular radialis flaps—parameters and correlations of postoperative pain management

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Abstract

Objectives

Postoperative pain management is of highest interest for patients undergoing maxillofacial surgery including microvascular reconstructive surgery. Currently, there is a lack of information regarding process and outcome of postoperative pain management after microvascular reconstruction.

Materials and methods

In a prospective clinical study, 31 adults were evaluated on the first postoperative day following microvascular reconstruction with a radial forearm flap using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It enables a standardized assessment of patients’ characteristics, pain parameters, outcome and pain therapy process parameters.

Results

Pain management consisted predominately of premedication with midazolam, sufentanil and metamizol intraoperatively, piritramid in the intensive care unit and metamizol, tramadol and fentanyl patches on ward. Nineteen patients (61.3 %) showed inadequate pain management with pain levels ≥4. Among other significant relations, patients exhibiting an age below the median presented significant higher levels of pain under strain (p = .041) and maximum pain (p = .006) as well as rate of breathing (p = .009) and mood (p = .006) disturbance. Performance of pain counselling showed specific impact on pain under strain (p = .008), maximum pain (p = .004) and satisfaction with pain intensity (p = .001). Whether microvascular reconstruction was performed with primary or secondary intention or performance of a neck dissection did not show significant influence.

Conclusions

QUIPS helped us to adequately evaluate the procedure-specific quality of postoperative management following microvascular reconstruction with a radial forearm flap. It helped us to identify a surprisingly high amount of inadequate pain management. Postoperative pain levels seem to be primarily influenced by the performed reconstruction.

Clinical relevance

Establishment of a continuous and procedure-specific evaluation of postoperative pain levels should help to avoid inadequate pain management, which is widely prevalent according to the literature and our study. Preoperative pain counselling is essential and should be procedure specific to be its best.

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References

  1. Kehlet H (2004) Effect of postoperative pain treatment on outcome-current status and future strategies. Langenbeck’s Arch Surg 389:244–249. doi:10.1007/s00423-004-0460-4

    Article  Google Scholar 

  2. Kehlet H, Wilkinson RC, Fischer HB, Camu F (2007) PROSPECT: evidence-based, procedure-specific postoperative pain management. Best Pract Res Clin Anaesthesiol 21:149–159

    Article  PubMed  Google Scholar 

  3. Gartner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H (2009) Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA 302:1985–1992. doi:10.1001/jama.2009.1568

    Article  PubMed  Google Scholar 

  4. Rathmell JP, Wu CL, Sinatra RS, Ballantyne JC, Ginsberg B, Gordon DB, Liu SS, Perkins FM, Reuben SS, Rosenquist RW, Viscusi ER (2006) Acute post-surgical pain management: a critical appraisal of current practice, December 2–4, 2005. Reg Anesth Pain Med 31:1–42. doi:10.1016/j.rapm.2006.05.002

    PubMed  Google Scholar 

  5. Apfelbaum JL, Chen C, Mehta SS, Gan TJ (2003) Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 97:534–540 table of contents

    Article  PubMed  Google Scholar 

  6. Benhamou D, Berti M, Brodner G, De Andres J, Draisci G, Moreno-Azcoita M, Neugebauer EA, Schwenk W, Torres LM, Viel E (2008) Postoperative Analgesic Therapy Observational Survey (PATHOS): a practice pattern study in 7 central/southern European countries. Pain 136:134–141. doi:10.1016/j.pain.2007.06.028

    Article  PubMed  Google Scholar 

  7. Fries BE, Simon SE, Morris JN, Flodstrom C, Bookstein FL (2001) Pain in U.S. nursing homes: validating a pain scale for the minimum data set. Gerontologist 41:173–179

    Article  PubMed  Google Scholar 

  8. Gureje O, Simon GE, Von Korff M (2001) A cross-national study of the course of persistent pain in primary care. Pain 92:195–200

    Article  PubMed  Google Scholar 

  9. Warfield CA, Kahn CH (1995) Acute pain management. Programs in U.S. hospitals and experiences and attitudes among U.S. adults. Anesthesiology 83:1090–1094

    Article  PubMed  Google Scholar 

  10. Fletcher D, Fermanian C, Mardaye A, Aegerter P (2008) A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges. Pain 137:441–451. doi:10.1016/j.pain.2008.02.026

    Article  PubMed  Google Scholar 

  11. Mularski RA, White-Chu F, Overbay D, Miller L, Asch SM, Ganzini L (2006) Measuring pain as the 5th vital sign does not improve quality of pain management. J Gen Intern Med 21:607–612. doi:10.1111/j.1525-1497.2006.00415.x

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gordon DB, Dahl JL (2004) Quality improvement challenges in pain management. Pain 107:1–4

    Article  PubMed  Google Scholar 

  13. Meissner W, Mescha S, Rothaug J, Zwacka S, Goettermann A, Ulrich K, Schleppers A (2008) Quality improvement in postoperative pain management: results from the QUIPS project. Dtsch Arztebl Int 105:865–870. doi:10.3238/arztebl.2008.0865

    PubMed  PubMed Central  Google Scholar 

  14. Wolff K-D, Hölzle F (2011) Raising of microvascular flaps—a systematic approach. Springer-Verlag, Berlin Heidelberg

    Book  Google Scholar 

  15. Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM (2000) Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth 84:6–10

    Article  PubMed  Google Scholar 

  16. Sommer M, Geurts JW, Stessel B, Kessels AG, Peters ML, Patijn J, van Kleef M, Kremer B, Marcus MA (2009) Prevalence and predictors of postoperative pain after ear, nose, and throat surgery. Arch Otolaryngol Head Neck Surg 135:124–130. doi:10.1001/archoto.2009.3

    Article  PubMed  Google Scholar 

  17. Ballantyne JC, Carr DB, deFerranti S, Suarez T, Lau J, Chalmers TC, Angelillo IF, Mosteller F (1998) The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg 86:598–612

    Article  PubMed  Google Scholar 

  18. Beattie WS, Buckley DN, Forrest JB (1993) Epidural morphine reduces the risk of postoperative myocardial ischaemia in patients with cardiac risk factors. Can J Anaesth 40:532–541. doi:10.1007/BF03009738

    Article  PubMed  Google Scholar 

  19. Neugebauer E, Sauerland S, Keck V, Simanski C, Witte J (2003) Surgical pain management. A Germany-wide survey including the effect of clinical guidelines. Chirurg 74:235–238. doi:10.1007/s00104-003-0615-9

    Article  PubMed  Google Scholar 

  20. Gordon DB, Dahl JL, Miaskowski C, McCarberg B, Todd KH, Paice JA, Lipman AG, Bookbinder M, Sanders SH, Turk DC, Carr DB (2005) American Pain Society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force. Arch Intern Med 165:1574–1580. doi:10.1001/archinte.165.14.1574

    Article  PubMed  Google Scholar 

  21. Meissner W, Ullrich K, Zwacka S (2006) Benchmarking as a tool of continuous quality improvement in postoperative pain management. Eur J Anaesthesiol 23:142–148. doi:10.1017/S026502150500205X

    Article  PubMed  Google Scholar 

  22. Meissner W (2010) Focus on pain. quality assurance in pain treatment. Anasthesiol Intensivmed Notfallmed Schmerzther 45:718–719. doi:10.1055/s-0030-1268874

    Article  PubMed  Google Scholar 

  23. Hyllested M, Jones S, Pedersen JL, Kehlet H (2002) Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesth 88:199–214

    Article  PubMed  Google Scholar 

  24. Lehmkuhl D, Meissner W, Neugebauer EA (2011) Evaluation of the "initiative pain-free clinic" for quality improvement in postoperative pain management. A prospective controlled study. Schmerz 25:508–515. doi:10.1007/s00482-011-1054-z

    Article  PubMed  Google Scholar 

  25. Laubenthal H, Deutsche Interdisziplinäre Vereinigung für Schmerztherapie (2008) S3-Leitlinie Behandlung akuter perioperativer und posttraumatischer Schmerzen mit 97 Tabellen. Dt. Ärzte-Verl, Köln

    Google Scholar 

  26. Raschke GF, Peisker A, Rieger U, Djedovic G, Guentsch A, Schaefer O, Venth E, Dammeier MG, Meissner W (2015) Quality of postoperative pain management after midfacial fracture repair—an outcome-oriented study. Clin Oral Investig 19:619–625. doi:10.1007/s00784-014-1283-5

    Article  PubMed  Google Scholar 

  27. Savoia G, Alampi D, Amantea B, Ambrosio F, Arcioni R, Berti M, Bettelli G, Bertini L, Bosco M, Casati A, Castelletti I, Carassiti M, Coluzzi F, Costantini A, Danelli G, Evangelista M, Finco G, Gatti A, Gravino E, Launo C, Loreto M, Mediati R, Mokini Z, Mondello E, Palermo S, Paoletti F, Paolicchi A, Petrini F, Piacevoli Q, Rizza A, Sabato AF, Santangelo E, Troglio E, Mattia C (2010) Postoperative pain treatment SIAARTI Recommendations 2010. Short version. Minerva Anestesiol 76:657–667

    PubMed  Google Scholar 

  28. Meissner W, Leyendecker P, Mueller-Lissner S, Nadstawek J, Hopp M, Ruckes C, Wirz S, Fleischer W, Reimer K (2009) A randomised controlled trial with prolonged-release oral oxycodone and naloxone to prevent and reverse opioid-induced constipation. Eur J Pain 13:56–64. doi:10.1016/j.ejpain.2008.06.012

    Article  PubMed  Google Scholar 

  29. Bisgaard T, Klarskov B, Rosenberg J, Kehlet H (2001) Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain 90:261–269

    Article  PubMed  Google Scholar 

  30. Catananti C, Gambassi G (2010) Pain assessment in the elderly. Surg Oncol 19:140–148. doi:10.1016/j.suronc.2009.11.010

    Article  PubMed  Google Scholar 

  31. Sjoling M, Nordahl G, Olofsson N, Asplund K (2003) The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management. Patient Educ Couns 51:169–176

    Article  PubMed  Google Scholar 

  32. Doering S, Katzlberger F, Rumpold G, Roessler S, Hofstoetter B, Schatz DS, Behensky H, Krismer M, Luz G, Innerhofer P, Benzer H, Saria A, Schuessler G (2000) Videotape preparation of patients before hip replacement surgery reduces stress. Psychosom Med 62:365–373

    Article  PubMed  Google Scholar 

  33. Ettrich U, Seifert J, Scharnagel R, Gunther KP (2007) A multimodal and multidisciplinary postoperative pain management concept. Der Orthopade 36(544):546–551. doi:10.1007/s00132-007-1103-6

    Google Scholar 

  34. Blanchard D, Bollet M, Dreyer C, Binczak M, Calmels P, Couturaud C, Espitalier F, Navez M, Perrichon C, Testelin S, Albert S, Morinière S, SFORL Work Group (2014) Management of somatic pain induced by head and neck cancer treatment: pain following radiation therapy and chemotherapy. Guidelines of the French Otorhinolaryngology Head and Neck Surgery Society (SFORL). Eur Ann Otorhinolaryngol Head Neck Dis 131:253–256. doi:10.1016/j.anorl.2014.07.001

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany

    Gregor F. Raschke, Andre Peisker, Daria Porwit, Marta Gomez Dammeier & Stefan Schultze-Mosgau

  2. Department of Anesthesiology and Intensive Care Medicine, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany

    Winfried Meissner

  3. Department of Plastic & Aesthetic, Reconstructive and Hand Surgery, St. Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany

    Gabriel Djedovic & Ulrich Rieger

  4. Marquette University School of Dentistry, Milwaukee, WI, USA

    Arndt Guentsch

Authors
  1. Gregor F. Raschke
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  2. Winfried Meissner
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  3. Andre Peisker
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  4. Gabriel Djedovic
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  5. Ulrich Rieger
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  9. Stefan Schultze-Mosgau
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Corresponding author

Correspondence to Gregor F. Raschke.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

There were no sources of funding or financial relationships of any author.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Prior to the start of study, the local ethics committee of the University Jena gave its approval.

Informed consent

All patients willing to participate gave their consent before being enrolled in the study.

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Raschke, G.F., Meissner, W., Peisker, A. et al. Cranio-maxillofacial reconstruction with microvascular radialis flaps—parameters and correlations of postoperative pain management. Clin Oral Invest 21, 429–436 (2017). https://doi.org/10.1007/s00784-016-1809-0

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  • DOI: https://doi.org/10.1007/s00784-016-1809-0

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