Efficacy of local anaesthetic wound infusion to reduce acute and chronic postoperative pain after neck dissection in patients with head and neck cancer

80% of all patients with head and neck cancer (HNC) undergoing neck dissection (ND) develop postoperative acute and/or chronic, mostly neuropathic pain with detrimental effects on quality of life. The aim of the present study was to investigate the efficacy of continuous incisional wound infusion of local anesthetic to improve postoperative pain management after ND.

30 patients were treated with oral analgesics (group 1) and 30 patients with an intraoperatively applied pain catheter (ropivacaine 0,2%, 3 ml/h) (group 2) for 3 postoperative days (POD) (n = 60). The primary efficacy endpoint was defined as the pain severity (numeric rating scale (NRS): 0 = no pain-10 = worst possible pain). Pain assessment was conducted by using the questionnaire of the German-wide project “Quality Improvement in Postoperative Pain Treatment” (QUIPS) as well as the painDETECT® questionnaire to identify neuropathic components. Secondary endpoints comprised analgesic score, quality of life (SF36 questionnaire) and side effects.

Patient's demographic, clinical and surgical data did not vary significantly between both groups. The average pain on ambulation, maximal and minimal pain in group 1 (Ø 62,3 years; 16,7% ♀) and group 2 (Ø 66 years; 30% ♀) were 3.17 and 1,18 on the first (p = 0,001), 3,17 and 1,93 on the second (p = 0,028) and 2,21 and 1,51 on the third postoperative day (p = 0,207). On day 4 there was a significant difference regarding quality of life in favor of group 2 (p = 0,009). The score for painDETECT® was significant higher in group 1 on day 2 than in group 2 (p = 0,022). There were no catheter-associated side effects.

The pain catheter led to a significant lower consumption of non-opioid and opioid analgesics alongside with fewer side effects.

Publication History

Publication Date:
18 April 2018 (online)