ORIGINAL RESEARCH Treatment of pain after head and neck surgeries: Control of acute pain after head and neck oncological surgeries Ziv Gil, MD, PhD, Darryl B. Smith, BDS, Nissim Marouani, MD, Avi Khafif, MD, and Dan M. Fliss, MD, Tel-Aviv, Israel OBJECTIVE: To devise an effective postoperative analgesic protocol. STUDY DESIGN AND SETTING: Two consecutive groups participated in this study. In the first group (n  100), the pain- control management was pro re nata (PRN). In the second group, (n  109) we tailored a procedure-specific pain-control protocol for each patient according to the level of pain recorded in the first group. These patients were treated with analgesics given at prede- termined hours. Pain was evaluated by using a verbal scale of 1 to 10. RESULTS: In the first group, a significant reduction in the level of pain was monitored 1 hour after PRN drug administration; however, patients reported the return of pain several hours later, after the drug effect subsided. Overall, the patients suffered a substantial level of pain during the entire postoperative period. In the second group, significant reduction in the level of pain was recorded throughout the hospitalization. CONCLUSION: The PRN protocol is not adequate for manage- ment of pain after head and neck surgeries. SIGNIFICANCE: We can substantially reduce our patients’ postoperative pain by adopting a procedure-specific analgesic reg- imen instead of a PRN regimen. EBM rating: B-3b. © 2006 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved. E stimating pain in patients undergoing oncological sur- geries has become a subject of increasing importance. The level of pain is assessed in an effort to improve post- operative analgesia and resultant patient comfort, to pro- mote restoration of the patient’s daily function as early as possible after the operation, and to accelerate his/her return to normal life. 1 The extent of pain can be measured only by the patient himself/herself because neither his/her caregiver nor surgeon has reliable tools for doing so. 2 Routine pain evaluation after surgery can serve as a guideline for tailor- ing the most appropriate pain-control regimen for a given patient. The technical development of craniofacial, skull-base, and reconstructive surgery has had a major positive impact on the long-term survival of patients with tumors in those anatomical areas. These procedures, however, involve a considerable level of pain during the early postoperative period. 3 Numerous studies have assessed pain issues in oncological patients during the last decade, 4 but the levels of pain after head and neck surgery in general and cranio- facial or skull-base procedures in particular have not been systematically evaluated. Although many analgesic regi- mens are available (eg, pro re nata [PRN], scheduled dosing, and intravenous patient-controlled analgesia [IV-PCA]), lit- tle is known about the optimal therapeutic modality for the treatment of acute postoperative pain after head and neck procedures. The aim of this study was to assess the level of pain in patients undergoing oncological head and neck surgeries and to develop a protocol to best treat pain during the early postoperative period. To this end, we performed a prospec- tive, nonrandomized study designed to estimate the analge- sic efficacy of a PRN protocol, which had been used in our institute as a basic pain treatment regimen. We performed an observational study of PRN patients and then used these From the Departments of Otolaryngology–Head and Neck Surgery (Drs Gil, Smith, Khafif, and Fliss); and The Acute Pain Service (Dr Marouani); Tel Aviv Sourasky Medical Center, Sackler Faculty of Medi- cine, Tel-Aviv University. Reprint requests: Ziv Gil, MD, PhD, Head and Neck Service, Depart- ment of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021. E-mail address: ziv@baseofskull.org Otolaryngology–Head and Neck Surgery (2006) 135, 182-188 0194-5998/$32.00 © 2006 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved. doi:10.1016/j.otohns.2006.03.005