Background: This study examines the association of multimodal analgesia (MMA) protocol for head and neck microvascular reconstruction with postoperative safety and opioid use.
Methods: Retrospective, intention-to-treat analysis of 226 patients undergoing head and neck microvascular reconstruction between January 1, 2014 and August 30, 2018 at a tertiary-care hospital following MMA protocol implementation. Multivariable models examined outcomes of interest.
Results: There were no differences between groups in frequency of bleeding, return to operating room, complete flap loss, readmissions, wound complications, and 30-day mortality. Patients in MMA protocol experienced reduced likelihood of partial flap loss (OR 0.18, confidence interval 0.04-0.91), meaningful reduction in postoperative opioid use (cumulative inpatient morphine equivalents [64 vs 141 mg; P < .001], daily morphine equivalents [8 vs 22 mg/d; P < .001]; and 22.5% lower frequency of opioid prescription at discharge [55.6% vs 78.1%; P = .001]).
Conclusions: In patients undergoing head and neck microvascular reconstruction, MMA is safe and associated with reduced postoperative opioid use.
Keywords: NSAIDs; free flap; microvascular; multimodal analgesia; narcotics; opioid; outcomes; reconstruction.
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