Transoral robotic surgery – time for consensus on pain assessment. A review

Abstract

Background

In Head and Neck surgery Transoral Robotic Surgery (TORS) is evolving as a key treatment option for benign and malignant lesions in the oropharynx. Even so, postoperative pain is one of the primary early complaints following TORS. Well established evidence-based procedure specific pain treatment guidelines are available for a variety of other surgical specialties. However, there are no guidelines for TORS

Aim

This review describes the available data of early pain intensity following TORS during rest and procedure related activity.

Methods

Literature concerning pain in the immediate postoperative phase following TORS were obtained from two literature databases

Results

Most data on pain intensity following TORS are based upon a numeric rating scale, e.g. the Visual Analogue Scale and/or analgesic demands. Only one randomized clinical trial is available reflecting that the literature is mainly based on retrospective and a few prospective studies. Only one study analyzed pain during relevant functionality, i.e. swallowing. Overall, the studies suffer from a non-standardized approach and there is a need for transparent information concerning the timing of pain ratings and methodology

Conclusions

The evidence for optimal pain control is limited, particularly during surgical relevant activity. Postoperative pain rating during activity is a fundamental element in pain trials in order to enhance recovery thereby calling for future consensus on assessment methodology

Chinese Abstract

背景：在头颈外科手术中, 经口机器人手术 (TORS) 正在发展成为一种口咽部良性和恶性病变关键的治疗方法的选择。 即便如此, 术后疼痛还是TORS 后的主要早期投诉之一。 完善的循证程序特定疼痛治疗指南适用于各种其他外科专业。 然而, 对于

TORS 还没有这样的指南

目的：本文描述了休息和手术相关活动期间 TORS 后早期疼痛强度的可用数据。

方法：有关 TORS 术后即刻疼痛的文献取自两个文献数据库。

结果：TORS 后疼痛强度的大多数数据都是基于数字评级量表, 例如, 视觉模拟量表和/或镇痛需求。 只有一项随机临床试验存在, 反映了这类文献主要基于回顾性研究和一些前瞻性研究。 只有一项研究分析相关功能（即吞咽）期间的疼痛。 总体而言, 这些研究因非标准化方法而深受其害, 并且需要有关疼痛评级的时间和方法的透明信息。

结论：最佳疼痛控制的证据有限, 特别是在手术相关活动期间。 术后活动期间的疼痛评级是疼痛试验的一个基本要素, 以便加强康复。因此, 我们呼吁未来就评估方法达成共识。

Keywords:

• Pain
• recovery
• transoral robotic surgery

Ethical statement

Not applicable, the article is a literature review.

Disclosure statement

The authors declare no potential conflict of interest

Data availability

Not applicable

Additional information

Funding

This study was supported by a private non-profit foundation (Candys Foundation), Research grant 2019-304