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Pain management with popliteal block for fibular graft harvesting in head and neck reconstruction; a randomised double-blind placebo-controlled study

Persson, Karolina LU orcid ; Sjövall, Johanna LU ; Kander, Thomas LU orcid and Walther-Sturesson, Louise LU (2022) In Oral Oncology 128. p.1-7
Abstract

BACKGROUND AND OBJECTIVES: Curative treatment for locally advanced head and neck tumours often includes reconstructive surgery using a microvascular free flap. Effective recuperation is essential but may be impeded by postoperative donor site pain. The aim of this study was to evaluate the effects of a continuous popliteal block on postoperative pain after fibular graft harvesting.

MATERIAL AND METHODS: In this randomized double-blind placebo-controlled study adult patients scheduled for reconstructive head and neck surgery with a microvascular free fibular graft received an indwelling popliteal nerve block catheter and were randomized to receive continuous levobupivacaine/ropivacaine or placebo during the first postoperative... (More)

BACKGROUND AND OBJECTIVES: Curative treatment for locally advanced head and neck tumours often includes reconstructive surgery using a microvascular free flap. Effective recuperation is essential but may be impeded by postoperative donor site pain. The aim of this study was to evaluate the effects of a continuous popliteal block on postoperative pain after fibular graft harvesting.

MATERIAL AND METHODS: In this randomized double-blind placebo-controlled study adult patients scheduled for reconstructive head and neck surgery with a microvascular free fibular graft received an indwelling popliteal nerve block catheter and were randomized to receive continuous levobupivacaine/ropivacaine or placebo during the first postoperative week. Primary outcome was postoperative extremity pain assessed using the numerated rating scale (NRS). Secondary outcomes included opioid consumption.

RESULTS: In total 24 patients were included. The median (median, IQR [range]) postoperative extremity NRS scores was lower in the local anaesthetic (LA) group (2, 0-3 [0-10]) compared to the placebo group (2, 1-4 [0-10]), p = 0.008. The LA group also experienced fewer episodes of breakthrough pain, defined as NRS ≥ 4 (17% vs 33% of observations), p = 0.009. Furthermore, median (median, IQR [range]) opioid consumption the first postoperative week was lower in the LA group (109 mg, 74-134 [19-611]) compared to the placebo group (202 mg, 135-241 [78-749]), p = 0.010. No complications attributed to the blocks were observed.

CONCLUSION: Continuous popliteal block significantly reduced postoperative extremity pain and opioid consumption in patients undergoing fibular graft harvesting for head and neck reconstructive surgery.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Oral Oncology
volume
128
article number
105833
pages
1 - 7
publisher
Elsevier
external identifiers
  • pmid:35421821
  • scopus:85127789214
ISSN
1879-0593
DOI
10.1016/j.oraloncology.2022.105833
language
English
LU publication?
yes
additional info
Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.
id
e07e1078-a1e2-47a8-aa9b-c8501d5dd669
date added to LUP
2022-04-21 22:26:00
date last changed
2024-12-20 02:19:43
@article{e07e1078-a1e2-47a8-aa9b-c8501d5dd669,
  abstract     = {{<p>BACKGROUND AND OBJECTIVES: Curative treatment for locally advanced head and neck tumours often includes reconstructive surgery using a microvascular free flap. Effective recuperation is essential but may be impeded by postoperative donor site pain. The aim of this study was to evaluate the effects of a continuous popliteal block on postoperative pain after fibular graft harvesting.</p><p>MATERIAL AND METHODS: In this randomized double-blind placebo-controlled study adult patients scheduled for reconstructive head and neck surgery with a microvascular free fibular graft received an indwelling popliteal nerve block catheter and were randomized to receive continuous levobupivacaine/ropivacaine or placebo during the first postoperative week. Primary outcome was postoperative extremity pain assessed using the numerated rating scale (NRS). Secondary outcomes included opioid consumption.</p><p>RESULTS: In total 24 patients were included. The median (median, IQR [range]) postoperative extremity NRS scores was lower in the local anaesthetic (LA) group (2, 0-3 [0-10]) compared to the placebo group (2, 1-4 [0-10]), p = 0.008. The LA group also experienced fewer episodes of breakthrough pain, defined as NRS ≥ 4 (17% vs 33% of observations), p = 0.009. Furthermore, median (median, IQR [range]) opioid consumption the first postoperative week was lower in the LA group (109 mg, 74-134 [19-611]) compared to the placebo group (202 mg, 135-241 [78-749]), p = 0.010. No complications attributed to the blocks were observed.</p><p>CONCLUSION: Continuous popliteal block significantly reduced postoperative extremity pain and opioid consumption in patients undergoing fibular graft harvesting for head and neck reconstructive surgery.</p>}},
  author       = {{Persson, Karolina and Sjövall, Johanna and Kander, Thomas and Walther-Sturesson, Louise}},
  issn         = {{1879-0593}},
  language     = {{eng}},
  pages        = {{1--7}},
  publisher    = {{Elsevier}},
  series       = {{Oral Oncology}},
  title        = {{Pain management with popliteal block for fibular graft harvesting in head and neck reconstruction; a randomised double-blind placebo-controlled study}},
  url          = {{http://dx.doi.org/10.1016/j.oraloncology.2022.105833}},
  doi          = {{10.1016/j.oraloncology.2022.105833}},
  volume       = {{128}},
  year         = {{2022}},
}