(0684) Multimodal Analgesia Regimens Following Transoral Robotic Surgery for HPV-Positive Oropharyngeal Squamous Cell Carcinoma

Introduction: Opioid and non-opioid analgesics are administered to mitigate pain secondary to transoral robotic surgery (TORS) for human papillomavirus positive oropharyngeal squamous cell carcinoma (HPV(+)OPSCC). In this retrospective study, we catalog postoperative pain control following TORS.

Methods: A retrospective chart review (2010-2019) at a single institution for patients undergoing TORS for HPV(+)OPSCC was performed for baseline, perioperative and postoperative clinical characteristics. Moderate pain was defined as 5 to 6, and severe pain as > 7 on standard 11-point numeric rating score, and deep sedation as Richmond Agitation and Sedation Score of –4 or –5. Patients with prior history of oropharyngeal cancer, synchronous primary tumors, metastatic disease, or who underwent free flap reconstruction were excluded.

Results: In total, 569 patients met criteria, with 513 (90.1%) being male, having a mean age of 58.2 ± 8.7 years and 235 (44.7%) having Adult Comorbidity Evaluation-27 of 0. Oncological characteristics included 491 (86.3%) having pT1/2 (n = 491) with 312 (59.2%) having tonsil and 226 (40.8%) base of tongue location. On postoperative day (POD) 0, 569 (100%) patients were administered opioids, 499 (87.7%) acetaminophen, 144 (25.3%) nonsteroidal analgesic drugs (NSAIDs), 132 (23%) gabapentin, and 219 (38.5%) steroids. On POD1, 461 (81%) patients were administered opioids, 553 (97.2%) acetaminophen, 212 (37.3%) NSAIDs, 196 (34.4%) gabapentin, and 161 (28.3%) steroids. In the first 24 hours, 156 (27.4%) patients reported moderate and 137 (30.5%) severe pain. Sedation was noted in 326 (57.9%) patients with deep sedation in 2 (0.4%) patients.

Conclusions: Moderate to severe pain was common following TORS whereas deep sedation was rare. These findings highlight the need for further study to optimize analgesic regimens for TORS surgery.