POSTOPERATIVE PAIN MANAGEMENT IN RECONSTRUCTIVE ONCOLOGIC SURGERY OF THE HEAD AND NECK REGION – AN OBSERVATIONAL STUDY

A. Lombardo, E. Fontana, S. Iannarino, A. Mariotto, F. Stivala, G. Riva, M. Miletta, A. Todisco, M. Paleologo, G. Pecorari | A.O.U. City of Health and Science of Turin, Molinette Hospital

BACKGROUND
Patients undergoing major head and neck oncologic surgery experience severe expected pain that peaks in the hours immediately following surgery and gradually decreases over the next 48–72 hours. Uncontrolled pain exposes patients to a higher risk of complications that compromise healing and quality of life. With the aim of achieving effective pain control, an analgesic therapy protocol was developed, and a prospective observational study was conducted to evaluate its safety and efficacy outcomes.
METHODS
At the Otorhinolaryngology department of the Molinette Hospital in Turin, from January 2023 to January 2025, 60 patients were included (51 men and 9 women, aged between 36 and 87 years). Administered analgesic therapy:
- Induction dose: Paracetamol 1 g + Tramadol 1.5 mg/kg + Alizapride 50 mg
- Upon awakening: Tramadol 400–600 mg + Alizapride 150 mg in 70–76 ml of normal saline solution, administered via elastomeric pump at a rate of 2 ml/h for 48 hours.
Rescue dose if VAS > 5: Morphine 2–5 mg.
In the ward:
o Rescue dose if pain > 3: Tramadol 50 mg in 100 ml of normal saline solution over 15 minutes (infusion rate 400 ml/h), up to twice daily
o Alternatively, Ketorolac 15–30 mg every 8 hours
The studied parameters were: Age, Sex, Comorbidities, Administered analgesic therapy, Pain scores during the 48 hours post-surgery, PAOS, Nausea and vomiting, Level of sedation. The collected data were entered into a Microsoft Excel worksheet. The Gaussian distribution of each variable was assessed using the mean and standard deviation (SD); in the presence of outliers, the median and interquartile range (25%–75%) were used. Pain was assessed using the NRS scale (0–10).
RESULTS
First 12 hours (T0–T12): mean pain score (NRS) 0.57, with 74.77% of measurements at NRS 0.
T12–T24: mean pain score NRS 0.67, with 75.16% of measurements at NRS 0.
T24–T48: mean pain score NRS 0.28, with 87.34% of measurements at NRS 0.
Rescue doses administered: 16
Nausea: 9/60 patients (15%)
Vomiting: 2/60 patients (3.33%)
No changes in PAOS, heart rate, or oxygen saturation.
CONCLUSIONS
Analysis of the results showed good pain control throughout the observation period, with mean pain scores consistently below NRS = 1. The cumulative data indicate that nearly all pain measurements at 48 hours were NRS = 0. The number of rescue doses was relatively low, demonstrating the effectiveness of the administered analgesic therapy. Outcomes related to nausea, vomiting, and vital signs were also positive. In conclusion, the analgesic protocol proved to be effective in terms of good pain control and safe with regard to side effects—leading to significant positive impacts on care and the patient’s quality of life.