Opioid sparing multimodal analgesia treats pain after head and neck microvascular reconstruction.

[OBJECTIVE] To compare pain control (opioid consumption and postsurgical pain scores) in head and neck (H&N) free flap reconstruction patients who undergo traditional means of postoperative analgesia including use of opioids versus a novel protocol that includes ketamine and gabapentin.

[METHODS] Single-institution retrospective cohort study.

[RESULTS] Eighty-six patients who underwent H&N free flap reconstruction from 2015 to 2018 were included. Forty-three patients were in the control cohort treated with opioids only, and 43 patients were in the treatment group. There was a statistically significant decrease in opioid consumption in each of the first 5 postoperative days ranging from 80% to 83% in the treatment group. The daily pain scores were significantly lower in the treatment group in the first 2 postoperative days. At the 1-month postoperative visit, there was no significant difference in pain scores between the groups; however, by the 2-month visit, the treatment group reported significantly lower pain scores than the control group (P = 0.001). No adverse outcomes of ketamine or gabapentin were experienced.

[CONCLUSION] Ketamine and gabapentin are safe and effective analgesics in H&N free flap surgery that significantly decrease opioid use in the acute postoperative setting and may improve pain control.

[LEVEL OF EVIDENCE] 3a Laryngoscope, 130:1686-1691, 2020.