Postoperative pain after parotid surgery-comparison between superficial/total parotidectomy and extracapsular dissection: a prospective observational study.
Extracapsular dissection
Pain management
Parotid surgery
Patient-reported outcome measure
Postoperative pain
QUIPS
Quality management
Journal
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
ISSN: 1434-4726
Titre abrégé: Eur Arch Otorhinolaryngol
Pays: Germany
ID NLM: 9002937
Informations de publication
Date de publication:
03 Oct 2024
03 Oct 2024
Historique:
received:
11
06
2024
accepted:
11
09
2024
medline:
3
10
2024
pubmed:
3
10
2024
entrez:
3
10
2024
Statut:
aheadofprint
Résumé
To evaluate postoperative pain and discomfort after parotid surgery with regard to different surgical approaches. This clinical study was carried out at a single tertiary referral center (2021-2022) and included 2 groups of adult patients (mean age 56.6 ± 12.7 vs. 53.4 ± 14.1 years) following elective parotid surgery due to a parotid tumor of any entity. The first group (SP/TP group) consisted of 31 patients after superficial parotidectomy (SP) or total parotidectomy (TP) (n = 31). The second group (ECD group) included all patients who had undergone extracapsular dissection (ECD) (n = 51). Primary endpoints comprised pain on ambulation as well as maximum and minimum pain (NRS 0-10) on the first three postoperative days (PODs). A neuropathic pain component (evaluated on POD 1 and 3), the analgesic score (collected from the patient file on POD 1-3), treatment-related side-effects/pain-associated impairments, and patient satisfaction (all measured on the 1st POD) were defined as secondary endpoints. Patients were surveyed using the standardized and validated "Quality Improvement in Postoperative Pain Treatment" (QUIPS) questionnaire and the painDETECT® questionnaire. Comparisons were performed using independent t tests, Wilcoxon tests, and χ Looking at the first postoperative day, patients of both groups (SP/TP vs. ECD) reported comparable pain on ambulation (2.8 ± 2.0 vs. 2.6 ± 1.8; p = 0.628, r = 0.063), maximum (3.5 ± 2.2 vs. 3.5 ± 2.3; p = 0.992, r = 0.002) and minimum pain (1.1 ± 1.04 vs. 1.0 ± 1.2; p = 0.206, r = 0.157). Furthermore, there were no significant differences in pain-related restrictions or pain medication requirement. The patients in both groups were equally satisfied with their pain therapy (p = 0.282, R = 0.135). The sum score of the painDETECT® questionnaire delivered clearly negative (< 12) results on average (POD1: 6.81; POD3: 6.59); no significant difference between the groups was found (p = 0.991, R Neither surgical technique on the parotid gland was significantly superior to the other in terms of postoperative pain perception. Overall, postoperative pain can be classified as mild to moderate following parotid surgery. A neuropathic pain component could be excluded for the acute postoperative phase. The study was registered in the German Registry for Clinical Studies (DRKS) (application No.: DRKS00016520).
Identifiants
pubmed: 39361139
doi: 10.1007/s00405-024-08991-5
pii: 10.1007/s00405-024-08991-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Marchese-Ragona R, De Filippis C, Marioni G, Staffieri A (2005) Treatment of complications of parotid gland surgery. Acta Otorhinolaryngol Ital 25(3): 174–8. http://www.ncbi.nlm.nih.gov/pubmed/16450773 . Accessed 7 May 2017
Psychogios G, Vlastos I, Thölken R, Zenk J (2020) Warthin’s tumour seems to be the most common benign neoplasm of the parotid gland in Germany. Eur Arch Otorhinolaryngol 277(7):2081–2084. https://doi.org/10.1007/S00405-020-05894-Z
doi: 10.1007/S00405-020-05894-Z
pubmed: 32189070
Mantsopoulos K, Iro H (2022) Extracapsular dissection versus conventional parotidectomy: comparing ‘apples with oranges’? Int J Oral Maxillofac Surg 51(4):576–577. https://doi.org/10.1016/J.IJOM.2021.08.005
doi: 10.1016/J.IJOM.2021.08.005
pubmed: 34420833
Mantsopoulos K, Koch M, Iro H (2017) Extracapsular dissection as sole therapy for small low-grade malignant tumors of the parotid gland. Laryngoscope 127(8):1804–1807. https://doi.org/10.1002/lary.26482
doi: 10.1002/lary.26482
pubmed: 28145103
Mantsopoulos K, Koch M, Klintworth N, Zenk J, Iro H (2015) Evolution and changing trends in surgery for benign Parotid tumors. Laryngoscope 125(1):122–127. https://doi.org/10.1002/lary.24837
doi: 10.1002/lary.24837
pubmed: 25043324
Mashrah MA, Al-Sharani HM, Al-Aroomi MA, Abdelrehem A, Aldhohrah T, Wang L (2021) Surgical interventions for management of benign parotid tumors: systematic review and network meta-analysis. Head Neck 43(11):3631–3645. https://doi.org/10.1002/HED.26813
doi: 10.1002/HED.26813
pubmed: 34288212
Laskaris S et al (2022) Partial superficial parotidectomy versus extracapsular anatomical dissection for the treatment of benign parotid tumors. Acta Med Acad 51(2):85–91. https://doi.org/10.5644/AMA2006-124.376
doi: 10.5644/AMA2006-124.376
pubmed: 36318000
pmcid: 9982861
Martin H, Jayasinghe J, Lowe T (2020) Superficial parotidectomy versus extracapsular dissection: literature review and search for a gold standard technique. Int J Oral Maxillofac Surg 49(2):192–199. https://doi.org/10.1016/J.IJOM.2019.06.006
doi: 10.1016/J.IJOM.2019.06.006
pubmed: 31301925
Schapher M, Koch M, Goncalves M, Mantsopoulos K, Iro H (2021) Extracapsular dissection in pleomorphic adenomas of the parotid gland: results after 13 years of follow-up. Laryngoscope 131(2):E445–E451. https://doi.org/10.1002/lary.28696
doi: 10.1002/lary.28696
pubmed: 32396221
Apfelbaum JL, Chen C, Mehta SS, Gan TJ (2003) Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 97(2): 534–40, table of contents. http://www.ncbi.nlm.nih.gov/pubmed/12873949 . Accessed 28 Nov 2016
Dolin SJ, Cashman JN, Bland JM (2002) Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth 89(3): 409–23. http://www.ncbi.nlm.nih.gov/pubmed/12402719 . Accessed 28 Nov 2016
Kehlet H, Wilkinson RC, Fischer HBJ, Camu F and Prospect Working Group (2007) PROSPECT: evidence-based, procedure-specific postoperative pain management. Best Pract Res Clin Anaesthesiol 21(1): 149–59. http://www.ncbi.nlm.nih.gov/pubmed/17489225 , Accessed 15 Apr 2017
Neugebauer E, Sauerland S, Keck V, Simanski C, Witte J (2003) Surgical pain management. A Germany-wide survey including the effect of clinical guidelines. Chirurg 74(3):235–238. https://doi.org/10.1007/s00104-003-0615-9
doi: 10.1007/s00104-003-0615-9
pubmed: 12647080
Pschowski R, Motsch J (2008) Die postoperative Schmerztherapie. Wien Med Wochenschr 158(21–22):603–609. https://doi.org/10.1007/s10354-008-0608-x
doi: 10.1007/s10354-008-0608-x
pubmed: 19052705
Rathmell JP et al (2006) Acute post-surgical pain management: a critical appraisal of current practice, December 2–4, 2005. Reg Anesth Pain Med 31(4 Suppl 1):1–42. https://doi.org/10.1016/j.rapm.2006.05.002
doi: 10.1016/j.rapm.2006.05.002
pubmed: 16849098
Gerbershagen HJ, Aduckathil S, van Wijck AJM, Peelen LM, Kalkman CJ, Meissner W (2013) Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology 118(4):934–944. https://doi.org/10.1097/ALN.0b013e31828866b3
doi: 10.1097/ALN.0b013e31828866b3
pubmed: 23392233
Laubenthal H, Neugebauer E (2009) S3-Leitlinie „Behandlung akuter perioperativer und posttraumatischer Schmerzen. AWMF-Leitlinien-Register 041(001): 74–88. http://www.awmf.org/uploads/tx_szleitlinien/001-025l_S3_Behandlung_akuter_perioperativer_und_posttraumatischer_Schmerzen_abgelaufen.pdf . Accessed 3 May 2017
Cuschieri S (2019) The STROBE guidelines. Saudi J Anaesth 13(Suppl 1):S31–S34. https://doi.org/10.4103/SJA.SJA_543_18
doi: 10.4103/SJA.SJA_543_18
pubmed: 30930717
pmcid: 6398292
Meissner W, Ullrich K, Zwacka S (2006) Benchmarking as a tool of continuous quality improvement in postoperative pain management. Eur J Anaesthesiol 23(2):142–148. https://doi.org/10.1017/S026502150500205X
doi: 10.1017/S026502150500205X
pubmed: 16426469
Poller K, Volk GF, Wittekindt C, Meissner W, Guntinas-Lichius O (2011) Estimation of postoperative pain after tonsillectomy in adults using QUIPS: an instrument to improve postoperative pain management. Laryngorhinootologie 90(2):82–89. https://doi.org/10.1055/s-0030-1269848
doi: 10.1055/s-0030-1269848
pubmed: 21181618
Freynhagen R, Baron R, Gockel U, Tölle TR (2006) pain DETECT : a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 22(10):1911–1920. https://doi.org/10.1185/030079906X132488
doi: 10.1185/030079906X132488
pubmed: 17022849
FR, TTR, GU, BR (2016) The painDETECT project-far more than a screening tool on neuropathic pain. Curr Med Res Opin 32(6): 1033–1057. https://doi.org/10.1185/03007995.2016.1157460 .
Ben-Shachar M, Lüdecke D, Makowski D (2020) effectsize: estimation of effect size indices and standardized parameters. J Open Source Softw 5(56):2815. https://doi.org/10.21105/JOSS.02815
doi: 10.21105/JOSS.02815
Mair P, Wilcox R (2020) Robust statistical methods in R using the WRS2 package. Behav Res Methods 52(2):464–488. https://doi.org/10.3758/S13428-019-01246-W
doi: 10.3758/S13428-019-01246-W
pubmed: 31152384
Eldridge SM et al (2010) CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud. https://doi.org/10.1186/S40814-016-0105-8
doi: 10.1186/S40814-016-0105-8
Gerbershagen HJ, Rothaug J, Kalkman CJ, Meissner W (2011) Determination of moderate-to-severe postoperative pain on the numeric rating scale: a cut-off point analysis applying four different methods. Br J Anaesth 107(4):619–626. https://doi.org/10.1093/bja/aer195
doi: 10.1093/bja/aer195
pubmed: 21724620
Inhestern J et al (2015) Pain on the first postoperative day after head and neck cancer surgery. Eur Arch Otorhinolaryngol 272(11):3401–3409. https://doi.org/10.1007/S00405-014-3307-9
doi: 10.1007/S00405-014-3307-9
pubmed: 25261106
Foghsgaard S, Foghsgaard J, Homøe P (2007) Early post-operative morbidity after superficial parotidectomy: a prospective study concerning pain and resumption of normal activity. Clin Otolaryngol 32(1):54–57. https://doi.org/10.1111/j.1365-2273.2007.01315.x
doi: 10.1111/j.1365-2273.2007.01315.x
pubmed: 17298314
Koch M, Zenk J, Iro H (2010) Long-term results of morbidity after parotid gland surgery in benign disease. Laryngoscope 120(4):724–730. https://doi.org/10.1002/lary.20822
doi: 10.1002/lary.20822
pubmed: 20205175
Wolber P et al (2018) Patient’s perspective on long-term complications after superficial parotidectomy for benign lesions: Prospective analysis of a 2-year follow-up. Clin Otolaryngol 43(4):1073–1079. https://doi.org/10.1111/COA.13104
doi: 10.1111/COA.13104
pubmed: 29577637
“Chronische Schmerzen: Das „mixed pain concept“ als neue Rationale.” https://www.aerzteblatt.de/archiv/41906/Chronische-Schmerzen-Das-mixed-pain-concept-als-neue-Rationale . Accessed 20 Aug 2024
Hancock BD (1999) Clinically benign parotid tumours: local dissection as an alternative to superficial parotidectomy in selected cases. Ann R Coll Surg Eng 81(5): 299–301. http://www.ncbi.nlm.nih.gov/pubmed/10645170 . Accessed 31 May 2017
Rehberg E, Schroeder H-G, Kleinsasser O (1998) Chirurgie bei gutartigen Parotistumoren: Individuell angepaßte oder standardisierte radikale Eingriffe? Laryngorhinootologie 77(05):283–288. https://doi.org/10.1055/s-2007-996975
doi: 10.1055/s-2007-996975
pubmed: 9644676
Witt RL (2002) The significance of the margin in parotid surgery for pleomorphic adenoma. Laryngoscope 112(12):2141–2154. https://doi.org/10.1097/00005537-200212000-00004
doi: 10.1097/00005537-200212000-00004
pubmed: 12461331
McGurk M, Renehan A, Gleave EN, Hancock BD (1996) Clinical significance of the tumour capsule in the treatment of parotid pleomorphic adenomas. Br J Surg 83(12): 1747–9. http://www.ncbi.nlm.nih.gov/pubmed/9038558 . Accessed 30 May 2017
Prichard AJ, Barton RP, Narula AA (1992) Complications of superficial parotidectomy versus extracapsular lumpectomy in the treatment of benign parotid lesions. J R Coll Surg Edinb 37(3) 155–8. http://www.ncbi.nlm.nih.gov/pubmed/1328626 . Accessed 31 May 2017
Klintworth N, Zenk J, Koch M, Iro H (2010) Postoperative complications after extracapsular dissection of benign parotid lesions with particular reference to facial nerve function. Laryngoscope 120(3):484–490. https://doi.org/10.1002/lary.20801
doi: 10.1002/lary.20801
pubmed: 20112414
Plath M, Sand M, Cavaliere C, Plinkert PK, Baumann I, Zaoui K (2022) Long-term outcomes and quality of life following parotidectomy for benign disease. Acta Otorhinolaryngol Ital 42(3):215–222. https://doi.org/10.14639/0392-100X-N1728
doi: 10.14639/0392-100X-N1728
pubmed: 35880361
pmcid: 9330751
Gritsenko K, Khelemsky Y, Kaye AD, Vadivelu N, Urman RD (2014) Multimodal therapy in perioperative analgesia. Best Pract Res Clin Anaesthesiol 28(1):59–79. https://doi.org/10.1016/j.bpa.2014.03.001
doi: 10.1016/j.bpa.2014.03.001
pubmed: 24815967
Suffeda A, Meissner W, Rosendahl J, Guntinas-Lichius O (2016) Influence of depression, catastrophizing, anxiety, and resilience on postoperative pain at the first day after otolaryngological surgery: a prospective single center cohort observational study. Medicine. https://doi.org/10.1097/MD.0000000000004256
doi: 10.1097/MD.0000000000004256
pubmed: 27428236
pmcid: 4956830