Postoperative Pain Profile After Major Cervicofacial Cancer Surgery


  •   Fanny Garnier

  •   Cyrus Motamed

  •   Philippe Sitbon

  •   Jean Louis Bourgain


Background: Despite its anticipation, postoperative pain may be still poorly managed in some cases, such as in patients undergoing major cervicofacial cancer surgery. Indeed, the postoperative pain associated with these surgeries is complex and multifactorial.
Objective: To assess the profile of postoperative pain scores and opioid requirements in a cohort of consecutive patients undergoing major cancer cervicofacial surgery with or without reconstruction.
Methods: A cohort of 42 consecutive patients was studied. The following parameters were recorded: patients characteristics, type of surgery, preoperative medication preoperative pain scores, and postoperative pain score (5-point numerical verbal scale) upon arrival at the postanesthesia care unit (PACU) and at Day 1 to Day 7 (11-point visual numeric scale), the presence or absence of neuropathic and/or chronic pain one year later (determined by a phone interview), and morphine consumption.
Results: All patients had a pain score of less than 3 in the PACU. From postoperative day 1 to day 7, pain scores were extremely variable and stayed high or even increased up to 7 in many patients. At the one-year phone interview, some patients had neuropathic and chronic pain.
Discussion: Postoperative pain profiles in major cervicofacial cancer are complex, with high interindividual variability and with cases with neuropathic patterns and high pain scores that can last up to 7 days postoperatively.


Keywords: postoperative pain, cancer surgery, head and neck, cervicofacial, chronic pain


Mom T, Commun F, Derbal C, Dubray C, Eschalier A, Bost P, et al. [Postoperative pain evaluation in the surgery of head and neck cancers]. Rev Laryngol Otol Rhinol (Bord). 1996;117(2):93-6.

Sommer M, Geurts JW, Stessel B, Kessels AG, Peters ML, Patijn J, et al. Prevalence and predictors of postoperative pain after ear, nose, and throat surgery. Arch Otolaryngol Head Neck Surg. 2009;135(2):124-30.

Inhestern J, Schuerer J, Illge C, Thanos I, Meissner W, Volk GF, et al. Pain on the first postoperative day after head and neck cancer surgery. Eur Arch Otorhinolaryngol. 2015;272(11):3401-9.

Chaplin JM, Morton RP. A prospective, longitudinal study of pain in head and neck cancer patients. Head Neck. 1999;21(6):531-7.

Potter J, Higginson IJ, Scadding JW, Quigley C. Identifying neuropathic pain in patients with head and neck cancer: use of the Leeds Assessment of Neuropathic Symptoms and Signs Scale. J R Soc Med. 2003;96(8):379-83.

Buchakjian MR, Davis AB, Sciegienka SJ, Pagedar NA, Sperry SM. Longitudinal Perioperative Pain Assessment in Head and Neck Cancer Surgery. Ann Otol Rhinol Laryngol. 2017;126(9):646-53.

Lahtinen S, Koivunen P, Ala-Kokko T, Laurila P, Kaarela O, Liisanantti JH. Quality of life after free flap surgery for cancer of the head and neck in patients with or without postoperative complications. Eur Arch Otorhinolaryngol. 2018;275(10):2575-84.

Turan A, Leung S, Bajracharya GR, Babazade R, Barnes T, Schacham YN, et al. Acute Postoperative Pain Is Associated With Myocardial Injury After Noncardiac Surgery. Anesth Analg. 2020;131(3):822-9.

Bianchini C, Malago M, Crema L, Aimoni C, Matarazzo T, Bortolazzi S, et al. Post-operative pain management in head and neck cancer patients: predictive factors and efficacy of therapy. Acta Otorhinolaryngol Ital. 2016;36(2):91-6.

Hinther A, Nakoneshny SC, Chandarana SP, Wayne Matthews T, Dort JC. Efficacy of postoperative pain management in head and neck cancer patients. J Otolaryngol Head Neck Surg. 2018;47(1):29.

Espitalier F, Testelin S, Blanchard D, Binczak M, Bollet M, Calmels P, et al. Management of somatic pain induced by treatment of head and neck cancer: Postoperative pain. Guidelines of the French Oto-Rhino-Laryngology--Head and Neck Surgery Society (SFORL). Eur Ann Otorhinolaryngol Head Neck Dis. 2014;131(4):249-52.

Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E, et al. Development and validation of the Neuropathic Pain Symptom Inventory. Pain. 2004;108(3):248-57.

Mulvey MR, Boland EG, Bouhassira D, Freynhagen R, Hardy J, Hjermstad MJ, et al. Neuropathic pain in cancer: systematic review, performance of screening tools and analysis of symptom profiles. Br J Anaesth. 2017;119(4):765-74.

Melson TI, Boyer DL, Minkowitz HS, Turan A, Chiang YK, Evashenk MA, et al. Sufentanil sublingual tablet system vs. intravenous patient-controlled analgesia with morphine for postoperative pain control: a randomized, active-comparator trial. Pain Pract. 2014;14(8):679-88.

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-52.

Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, et al. Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41(6):1073-93.

Goddard G, Karibe H, McNeill C. Reproducibility of visual analog scale (VAS) pain scores to mechanical pressure. Cranio. 2004;22(3):250-6.

Liu WH, Aitkenhead AR. Comparison of contemporaneous and retrospective assessment of postoperative pain using the visual analogue scale. Br J Anaesth. 1991;67(6):768-71.

Berger VW. Can pain be quantified numerically? J Rheumatol. 2006;33(11):2364-5; author reply 5.

Myles PS, Urquhart N. The linearity of the visual analogue scale in patients with severe acute pain. Anaesth Intensive Care. 2005;33(1):54-8.

Shaw R, Beasley N. Aetiology and risk factors for head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S9-S12.

Bamonti PM, Moye J, Naik AD. Pain is associated with continuing depression in cancer survivors. Psychol Health Med. 2018;23(10):1182-95.

Linkov G, Morris LG, Shah JP, Kraus DH. First bite syndrome: incidence, risk factors, treatment, and outcomes. Laryngoscope. 2012;122(8):1773-8.

Gane EM, McPhail SM, Hatton AL, Panizza BJ, O'Leary SP. Predictors of health-related quality of life in patients treated with neck dissection for head and neck cancer. Eur Arch Otorhinolaryngol. 2017;274(12):4183-93.

Hojvig JH, Pedersen NJ, Charabi BW, Wessel I, Jensen LT, Nyberg J, et al. Microvascular reconstruction in head and neck cancer - basis for the development of an enhanced recovery protocol. JPRAS Open. 2020;26:91-100.


How to Cite
Garnier, F., Motamed, C., Sitbon, P., & Bourgain, J. L. (2021). Postoperative Pain Profile After Major Cervicofacial Cancer Surgery. European Journal of Clinical Medicine, 2(2), 1–6.