Opioid prescribing and consumption after head and neck free flap reconstruction: what is the evidence for multimodal analgesia?

Abstract

All opioids carry a risk of dependence, substance use disorder, and fatal overdose (1), and risk increases in proportion to the duration of opioid exposure (2). For patients with advanced head and neck cancer requiring ablative surgery and microvascular free tissue reconstruction, the risk of developing opioid use disorder is amplified by both the complexity of treatment and the prolonged recovery often required. Chronic opioid use is reported by 41–64% of head and neck cancer patients at 3 months after treatment (3,4). Although some patients receive opioid analgesia preoperatively for cancer-related pain, many patients undergoing head and neck cancer surgery have their initial exposure to opioids during or after surgery. In recent years, a growing number of investigators have investigated strategies to minimize persistent opioid use in this patient population, with an emphasis on opioid-sparing or reducing regimens.