Time course of subacute pain after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma versus traditional bilateral tonsillectomy in adults – a case–control study

Abstract

Objective: To examine pain after Transoral Robotic Surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) versus traditional bilateral tonsillectomy in adults.

Methods: Pain evolvement was assessed in a prospective case–control design of 16 consecutive patients treated with TORS for early stage OPSCC versus 12 patients, who underwent bilateral tonsillectomy on suspicion of malignant disease. The TORS group received an optimized analgesia regime of preoperative oral celecoxib and gabapentin, intra- and postoperative high-dose intravenous dexamethasone, and regular postoperative oral contalgin, gabapentin, celecoxib, paracetamol and rescue morphine. The tonsillectomy group received the departmental standard analgesia regime with low-dose preoperative oral dexamethasone, celecoxib and paracetamol. Postoperative regular analgesia consisted of oral NSAID and paracetamol with weak opioids prescribed as required. Pain intensity was recorded at rest and during swallowing twice a day.

Results: The median pain intensity on postoperative day (POD) 1–4 was 2 in the TORS group versus 4.5 in the tonsillectomy group. From POD 5-10 median pain intensity was 3.5 and 4, respectively. The median length of stay was 5 days in the TORS group and less than 24 hours in the tonsillectomy group.

Conclusion: With an optimized analgesia regime TORS for OPSCC can be performed with postoperative pain levels comparable to bilateral tonsillectomy in adults.

Chinese abstract

目的：研究相较于成人常规双侧扁桃体切除术后的疼痛, 口腔鳞状细胞癌（OPSCC）经口机器人手术（TORS）后的疼痛。

方法：对16例经TORS治疗的早期OPSCC连续患​​者进行的前瞻性病例对照设计中评估了疼痛演变, 并与12例因怀疑恶性疾病行双侧扁桃体切除术的患者进行对比。 TORS组接受了术前口服塞来昔布和加巴喷丁, 术中和术后高剂量静脉注射地塞米松以及术后口服康达金、加巴喷丁、塞来昔布、扑热息痛和营救性吗啡的镇痛方案。扁桃体切除组接受了医院标准的镇痛方案, 使用低剂量术前口服地塞米松、塞来昔布和扑热息痛。术后定期镇痛包括口服非甾体抗炎药和扑热息痛, 并根据需要开具弱阿片类药物。每天两次记录休息时和吞咽时的疼痛强度。

结果：术后（POD）第1-4天的中位疼痛强度在TORS组为2, 而在扁桃体切除组为4.5。两组术后第 5-10天的中位疼痛强度分别是3.5和4。 TORS组的中位住院时间为5天, 扁桃体切除组为24小时以下。

结论：通过优化镇痛方案, 可以进行OPSCC的TORS手术, 其术后疼痛水平与成人双侧扁桃体切除术相当。

Keywords:

• TORS
• pain
• VAS
• oropharyngeal cancer
• tonsillectomy
• squamous cell carcinoma

Disclosure statement

No potential conflict of interest was reported by the authors.