HEAD AND NECK Pain on the first postoperative day after head and neck cancer surgery Johanna Inhestern • Jenny Schuerer • Christina Illge • Ira Thanos • Winfried Meissner • Gerd Fabian Volk • Orlando Guntinas-Lichius Received: 22 August 2014 / Accepted: 22 September 2014 Ó Springer-Verlag Berlin Heidelberg 2014 Abstract Postoperative pain within the first 24 h after head and neck cancer (HNC) surgery was assessed. Factors influencing postoperative pain were identified. In a pro- spective cohort single center study 145 HNC patients rated their pain on the first postoperative day using question- naires of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including numeric rating scales (NRS, 0–10) for the determination of patient’s pain on ambulation, his maximal and minimal pain. QUIPS allowed a standardized assessment of patients’ character- istics and pain-related parameters. The influence of these parameters on the patients’ postoperative pain was esti- mated by univariate and multivariate statistical analysis. One-third had already pain prior to the surgical interven- tion. Overall, the mean pain on ambulation, maximal pain and minimal pain were 2.55 ± 2.36, 3.18 ± 2.86, and 1.38 ± 2.86 (NRS), respectively. 53 % of the patients had maximal pain scores [ 3. Multivariate analysis revealed independent predictors for more postoperative pain on ambulation: intensity of chronic preoperative pain, usage of non-opioids on ward, and existence of pain documentation on ward. Intensity of chronic preoperative pain and usage of non-opioids on ward were independent risk factors for more maximal pain. Intensity of chronic preoperative pain was independently associated to more minimal pain. Concerning pain management side effects, the risk for drowsiness increased with longer time of surgery. Postop- erative pain after HNC surgery is highly variable and seems often to be unnecessarily high. Many patients seem to receive less analgesia than needed or ineffective anal- gesic drug regimes. Keywords Postoperative pain Á Head and neck cancer Á Surgery Á Quality management Á QUIPS Introduction Postoperative pain therapy is an important part of periop- erative care and a fundamental right of head and neck cancer (HNC) patients as it is for any surgical patient. For adults it is known that appropriate management of post- operative pain reduces perioperative morbidity, complica- tions, hospital stay, and costs [1]. In general we know for adults that there seems to be a worldwide undersupply with adequate pain management after surgery [2, 3]. Recently, a prospective cohort study using data of 70,764 patients taking part in the Quality Improvement in Postoperative Pain Treatment (QUIPS) registry has shown that postop- erative pain on the first postoperative day is high in spite of perioperative pain management in many major thoracic and abdominal surgeries often performed for malignant dis- eases [4]. The authors concluded that these patients perhaps are given less analgesia than needed. How the situation is for HNC patients is unclear. Typical HNC procedures comprise a variety of small and fast operations but also of long and laborious surgeries. In general, there is a lack of knowledge about pain and specific Electronic supplementary material The online version of this article (doi:10.1007/s00405-014-3307-9) contains supplementary material, which is available to authorized users. J. Inhestern Á J. Schuerer Á C. Illge Á I. Thanos Á G. F. Volk Á O. Guntinas-Lichius (&) Department of Otorhinolaryngology, Jena University Hospital, Lessingstrasse 2, 07740 Jena, Germany e-mail: orlando.guntinas@med.uni-jena.de W. Meissner Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany 123 Eur Arch Otorhinolaryngol DOI 10.1007/s00405-014-3307-9