MMA lowers perioperative opioid use in head and neck surgery

  • Vu CN & al.
  • JAMA Otolaryngol Head Neck Surg
  • 18.06.2020

  • von Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Receiving preoperative multimodal analgesia (MMA) with ≥1 of celecoxib, gabapentin, and/or tramadol is associated with lower perioperative opioid use and a shorter stay in the postanesthesia care unit (PACU) in patients undergoing head and neck surgery with free flap reconstruction.

Why this matters

  • Patients undergoing this surgery are at increased risk for respiratory complications, which opioid use can exacerbate.

Study design

  • 357 patients undergoing head and neck surgery with free flap reconstruction received ≥1 celecoxib, gabapentin, and/or tramadol preoperatively (n=149) or no MMA (n=208).
  • Funding: None disclosed.

Key results

  • Lower mean morphine equivalent daily dose (MEDD) of opioid with MMA:
    • During surgery: 51.7 vs 67.9. 
      • Difference in means: −16.17 (95% CI, −20.81 to −11.52).
    • In the PACU: 11.7 vs 14.9.
      • Difference in means: −3.22 (95% CI, −6.40 to −0.03).
    • In surgery and PACU combined: 64.0 vs 82.2. 
      • Difference in means: −18.21 (95% CI, −24.10 to −12.32).
  • After multivariable analysis, MMA was associated (aORs; 95% CIs) with reduced opioid administered:
    • During surgery: 0.32 (0.20-0.52).
    • In the PACU: 0.55 (0.33-0.90). 
    • In surgery and PACU: 0.21 (0.12-0.36).
  • Shorter PACU stay with MMA: 3.11 vs 3.47 hours.
    • Difference in means: −0.36 (95% CI, −0.63 to −0.09).

Limitations

  • Single-center, retrospective.