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Original Investigation
From the American Head and Neck Society
December 2017

Multimodal Analgesia in Outpatient Head and Neck Surgery: A Feasibility and Safety Study

Author Affiliations
  • 1College of Medicine, University of Nebraska Medical Center, Omaha
  • 2Department of Head and Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha
  • 3Department of Anesthesiology, Nebraska Methodist Hospital, Omaha
JAMA Otolaryngol Head Neck Surg. 2017;143(12):1207-1212. doi:10.1001/jamaoto.2017.1773
Key Points

Question  Can multimodal analgesia techniques be safely applied in patients undergoing outpatient head and neck surgery?

Findings  This study found that in patients undergoing outpatient thyroid, parathyroid, and parotid surgery, multimodal analgesia techniques reliant on a preoperative acetaminophen and postdischarge nonnarcotic anti-inflammatory agent strategy allowed the majority of patients to avoid postdischarge narcotic use; patients were satisfied and had low pain scores, and there were no adverse events related to the altered analgesia strategy.

Meaning  A multimodal analgesia strategy is feasible, safe, and well tolerated by patients undergoing outpatient head and neck surgery, and may reduce the need for narcotic use.


Importance  Perioperative analgesia strategies that rely solely on narcotics may contribute to adverse effects and concerns about opioid abuse or dependence. Multimodal analgesia protocols incorporating nonnarcotic agents may reduce the need for postoperative narcotic use.

Objective  To evaluate the feasibility and safety of a multimodal analgesia protocol for outpatient head and neck surgical procedures and to identify the association of the multimodal analgesia protocol with postoperative pain perception scores and patient satisfaction.

Design, Setting, and Participants  Retrospective evaluation of prospectively collected data on adults who underwent outpatient thyroid, parathyroid, and parotid surgery between July 2016 and February 2017 at the head and neck surgery service of a tertiary care hospital using a multimodal analgesia strategy with use of immediate preoperative acetaminophen and gabapentin, and intention to treat with a nonnarcotic postoperative outpatient analgesia strategy.

Main Outcomes and Measures  Overall patient satisfaction scores, Overall Benefit of Analgesia Score (OBAS), and median resting and peak pain scores were recorded. Incidence of reliance on a narcotic-based postoperative outpatient analgesia strategy and adverse events related to altered analgesia strategy were identified.

Results  Sixty-four patients (48 [75%] female; mean [SD] age, 54.6 [14.3] years) underwent outpatient thyroid, parathyroid, or parotid surgery with use of a multimodal analgesia protocol. On a 10-point rating scale, patients reported low resting pain perception scores (median, 2 [range, 0-8]) and peak pain scores (median, 4 [range, 0-9]). The OBAS assessment for composite effectiveness of analgesia indicated a favorable median score of 1 (range, 0-10; permissible range, 0-28, with lower scores better). Thirty-nine (61%) patients were able to avoid postoperative narcotic use on discharge. Fifty-six (88%) patients reported “high” or “very high” satisfaction with the multimodal analgesia strategy. No complications related to bleeding, hematoma, significant adverse events, or readmissions were observed.

Conclusion and Relevance  A multimodal analgesia strategy was feasible and safe in patients undergoing outpatient head and neck surgery and may reduce the need for narcotic use. It was associated with low pain perception scores, favorable OBAS, and overall satisfaction scores. The role of multimodal analgesia needs additional evaluation through comparative effectiveness assessment vs conventional pain management strategies.