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Pain on the first postoperative day after head and neck cancer surgery

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Abstract

Postoperative pain within the first 24 h after head and neck cancer (HNC) surgery was assessed. Factors influencing postoperative pain were identified. In a prospective cohort single center study 145 HNC patients rated their pain on the first postoperative day using questionnaires of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including numeric rating scales (NRS, 0–10) for the determination of patient’s pain on ambulation, his maximal and minimal pain. QUIPS allowed a standardized assessment of patients’ characteristics and pain-related parameters. The influence of these parameters on the patients’ postoperative pain was estimated by univariate and multivariate statistical analysis. One-third had already pain prior to the surgical intervention. Overall, the mean pain on ambulation, maximal pain and minimal pain were 2.55 ± 2.36, 3.18 ± 2.86, and 1.38 ± 2.86 (NRS), respectively. 53 % of the patients had maximal pain scores >3. Multivariate analysis revealed independent predictors for more postoperative pain on ambulation: intensity of chronic preoperative pain, usage of non-opioids on ward, and existence of pain documentation on ward. Intensity of chronic preoperative pain and usage of non-opioids on ward were independent risk factors for more maximal pain. Intensity of chronic preoperative pain was independently associated to more minimal pain. Concerning pain management side effects, the risk for drowsiness increased with longer time of surgery. Postoperative pain after HNC surgery is highly variable and seems often to be unnecessarily high. Many patients seem to receive less analgesia than needed or ineffective analgesic drug regimes.

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References

  1. Savoia G, Alampi D, Amantea B et al (2010) Postoperative pain treatment SIAARTI recommendations 2010. Short version. Minerva Anestesiol 76(8):657–667

    CAS  PubMed  Google Scholar 

  2. 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(3):235–238

    Article  CAS  PubMed  Google Scholar 

  3. Rathmell JP, Wu CL, Sinatra RS et al (2006) Acute post-surgical pain management: a critical appraisal of current practice, December 2–4, 2005. Reg Anesth Pain Med 31(4 Suppl 1):1–42

    PubMed  Google Scholar 

  4. Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W (2013) Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology 118(4):934–944

    Article  PubMed  Google Scholar 

  5. Epstein JB, Hong C, Logan RM et al (2010) A systematic review of orofacial pain in patients receiving cancer therapy. Support Care Cancer 18(8):1023–1031

    Article  PubMed  Google Scholar 

  6. Meissner W, Mescha S, Rothaug J et al (2008) Quality improvement in postoperative pain management: results from the QUIPS project. Dtsch Arztebl Int 105(50):865–870

    PubMed Central  PubMed  Google Scholar 

  7. D’Hoore W, Sicotte C, Tilquin C (1993) Risk adjustment in outcome assessment: the Charlson comorbidity index. Methods Inf Med 32(5):382–387

    PubMed  Google Scholar 

  8. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (2010) AJCC cancer staging manual. Springer, New York

    Google Scholar 

  9. Wittekindt D, Wittekindt C, Schneider G, Meissner W, Guntinas-Lichius O (2012) Postoperative pain assessment after septorhinoplasty. Eur Arch Otorhinolaryngol 269(6):1613–1621

    Article  CAS  PubMed  Google Scholar 

  10. Finkensieper M, Poller K, Wittekindt C, Meissner W, Guntinas-Lichius O (2013) Postoperative pain assessment after functional endoscopic sinus surgery (FESS) for chronic pansinusitis. Eur Arch Otorhinolaryngol 270(1):157–166

    Article  PubMed  Google Scholar 

  11. Guntinas-Lichius O, Volk GF, Zaslansky R, Meissner W (2013) The first postoperative day: prospective evaluation of pain in adult otorhinolaryngologic surgery. Clin J Pain [Epub ahead of print]

  12. Mantha S, Thisted R, Foss J, Ellis JE, Roizen MF (1993) A proposal to use confidence intervals for visual analog scale data for pain measurement to determine clinical significance. Anesth Analg 77(5):1041–1047

    Article  CAS  PubMed  Google Scholar 

  13. van Dijk JF, van Wijck AJ, Kappen TH, Peelen LM, Kalkman CJ, Schuurmans MJ (2012) Postoperative pain assessment based on numeric ratings is not the same for patients and professionals: a cross-sectional study. Int J Nurs Stud 49(1):65–71

    Article  PubMed  Google Scholar 

  14. de Graeff A, de Leeuw JR, Ros WJ, Hordijk GJ, Blijham GH, Winnubst JA (2000) Long-term quality of life of patients with head and neck cancer. Laryngoscope 110(1):98–106

    Article  PubMed  Google Scholar 

  15. Biazevic MG, Antunes JL, Togni J, de Andrade FP, de Carvalho MB, Wunsch-Filho V (2008) Immediate impact of primary surgery on health-related quality of life of hospitalized patients with oral and oropharyngeal cancer. J Oral Maxillofac Surg 66(7):1343–1350

    Article  PubMed  Google Scholar 

  16. Gordon DB, Dahl JL, Miaskowski C et al (2005) American pain society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force. Arch Int Med 165(14):1574–1580

    Article  Google Scholar 

  17. Kehlet H, Wilkinson RC, Fischer HB, Camu F (2007) PROSPECT: evidence-based, procedure-specific postoperative pain management. Best Pract Res Clin Anaesthesiol 21(1):149–159

    Article  PubMed  Google Scholar 

  18. Gil Z, Smith DB, Marouani N, Khafif A, Fliss DM (2006) Treatment of pain after head and neck surgeries: control of acute pain after head and neck oncological surgeries. Otolaryngol Head Neck Surg 135(2):182–188

    Article  PubMed  Google Scholar 

  19. Caumo W, Schmidt AP, Schneider CN et al (2002) Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery. Acta Anaesthesiol Scand 46(10):1265–1271

    Article  CAS  PubMed  Google Scholar 

  20. Ip HY, Abrishami A, Peng PW, Wong J, Chung F (2009) Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology 111(3):657–677

    Article  PubMed  Google Scholar 

  21. Sommer M, Geurts JW, Stessel B et al (2009) Prevalence and predictors of postoperative pain after ear, nose, and throat surgery. Arch Otolaryngology Head Neck Surg 135(2):124–130

    Article  Google Scholar 

  22. Werner MU, Mjobo HN, Nielsen PR, Rudin A (2010) Prediction of postoperative pain: a systematic review of predictive experimental pain studies. Anesthesiology 112(6):1494–1502

    Article  PubMed  Google Scholar 

  23. Sommer M, de Rijke JM, van Kleef M et al (2010) Predictors of acute postoperative pain after elective surgery. Clin J Pain 26(2):87–94

    Article  PubMed  Google Scholar 

  24. Theunissen M, Peters ML, Bruce J, Gramke HF, Marcus MA (2012) Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain. Clin J Pain 28(9):819–841

    Article  PubMed  Google Scholar 

  25. Messerer B, Gutmann A, Weinberg A, Sandner-Kiesling A (2010) Implementation of a standardized pain management in a pediatric surgery unit. Pediatr Surg Int 26(9):879–889

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Jena University Hospital, Lessingstrasse 2, 07740, Jena, Germany

    Johanna Inhestern, Jenny Schuerer, Christina Illge, Ira Thanos, Gerd Fabian Volk & Orlando Guntinas-Lichius

  2. Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany

    Winfried Meissner

Authors
  1. Johanna Inhestern
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  2. Jenny Schuerer
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  3. Christina Illge
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  4. Ira Thanos
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  5. Winfried Meissner
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  6. Gerd Fabian Volk
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  7. Orlando Guntinas-Lichius
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Corresponding author

Correspondence to Orlando Guntinas-Lichius.

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Inhestern, J., Schuerer, J., Illge, C. et al. Pain on the first postoperative day after head and neck cancer surgery. Eur Arch Otorhinolaryngol 272, 3401–3409 (2015). https://doi.org/10.1007/s00405-014-3307-9

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  • DOI: https://doi.org/10.1007/s00405-014-3307-9

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