Opioid sparing multimodal analgesia treats pain after head and neck microvascular reconstruction

Objective To compare pain control (opioid consumption and postsurgical pain scores) in head and neck (H&N) free flap reconstruction patients who undergo traditional means of postoperative analgesia including use of opioids versus a novel protocol that includes ketamine and gabapentin. Methods Single‐institution retrospective cohort study. Results Eighty‐six patients who underwent H&N free flap reconstruction from 2015 to 2018 were included. Forty‐three patients were in the control cohort treated with opioids only, and 43 patients were in the treatment group. There was a statistically significant decrease in opioid consumption in each of the first 5 postoperative days ranging from 80% to 83% in the treatment group. The daily pain scores were significantly lower in the treatment group in the first 2 postoperative days. At the 1‐month postoperative visit, there was no significant difference in pain scores between the groups; however, by the 2‐month visit, the treatment group reported significantly lower pain scores than the control group ( P = 0.001). No adverse outcomes of ketamine or gabapentin were experienced. Conclusion Ketamine and gabapentin are safe and effective analgesics in H&N free flap surgery that significantly decrease opioid use in the acute postoperative setting and may improve pain control. Level of Evidence 3a Laryngoscope , 130:1686–1691, 2020