Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
BACKGROUND: Opioids have been a routine part of postoperative pain management for many years, but there is an urgent pressure to shift pain management away from opioids given startling statistics on opioid-related addiction and death, evidence that some patients may still be using opioids a year or more after surgery and the negative side effect profile of opioids. In otolaryngology, the recently published Clinical Practice Guidelines (CPG) and Enhanced Recovery After Surgery (ERAS) protocols recommend preoperative discussions with patients about the risks of opioids and the benefit of multimodal analgesia. However, ensuring patients receive standardized, accurate opioid-use educational material and finding the time to present such material in busy clinics is challenging.
HYPOTHESIS: Head and neck cancer patients undergoing free flap reconstruction will have improved perception of pain control and decreased opioid use in the immediate postoperative period when given a standardized pain management video versus routine preoperative counseling in clinic.
METHOD: Randomized control trial including a control group that received routine preoperative counseling and an intervention group that received routine preoperative counseling as well as access to a 5 minute animated video, based on the recent CPG publication and published ERAS guidelines, that explains postoperative pain expectations, addresses misconceptions of pain management, and discusses the components of the postoperative pain management plan. Both groups completed the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) validated survey on postoperative day (POD) 1 and POD 3. The primary endpoint is a 3 question sub-scale of the APS-POQ-R survey that addresses the Perception of Pain Care as described by Gordan et al. The secondary endpoint is the daily morphine milligram equivalents (MME) during their hospitalization. The accrual goal is 62 patients. This abstract reports the preliminary results of the initial 39 subjects.
RESULTS: 20 patients have been enrolled in the control group and 19 in the intervention group. Of the 39 observed patients, the 20 controls versus the 19 intervention subjects show clinically similar patient characteristics with a slightly higher incidence of soft tissue flaps versus bony flaps in the control group. Preliminary data shows that the intervention has been effective in Perception of Pain scores on POD 1. Those who received the intervention had average (SD) Pain Perception of 13.7 (6.9), compared to the control group who had an average of 17.0 (5.7). Patients who received the intervention also had lower MME on POD 1 – POD 3 compared to controls with an average (SD) of 12.9 (13.6), 13.0 (12.3), 9.5 (8.2) vs 17.0 (16.9), 14.9 (17.3), 12.8 (19.9), respectively.
CONCLUSION: Preliminary results of this prospective trial augmenting routine preoperative counseling of postoperative pain management with a standardized patient controlled video outlining pain expectations and management strategies show improved perception of pain in the group receiving the video teaching tool. Final results will have full statistical analysis and analyze perception of pain on POD 3 during the postoperative hospitalization timeframe.